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Clinical aspects of splenomegaly as a possible predictive factor of coronary artery changes in Kawasaki disease

  • Dong Wan Kang (a1) and Sung Hoon Kim (a1)



Although many clinical features that are not typically included in the diagnostic criteria for Kawasaki disease, such as gall bladder hydrops, are known to occur with Kawasaki disease, splenomegaly is not concerned. We investigated the relationship of splenomegaly with the development of coronary artery lesions in Kawasaki disease.

Methods and results

This retrospective descriptive study was conducted through a review of medical records of children with Kawasaki disease from March 2011 to February 2017. We analysed information regarding clinical presentation, treatment, hospital stay, and outcome. A total of 396 patients during this 6-year period met the enrolment criteria. Of these, 77 (23.4%) underwent abdominal ultrasonography during the treatment period. The patients included 46 males and 31 females with an average age of 35.8 ± 26.1 months. Gallbladder hydrops were detected in 32 patients, and acute acalculous cholecystitis was not found. Splenomegaly was detected in 21 patients. Kawasaki disease patients with gallbladder hydrops had no statistical difference in clinical or laboratory findings or in development of coronary artery lesions compared to patients without gallbladder hydrops. However, patients with splenomegaly belonged more to incomplete Kawasaki disease, had longer fever duration, had more frequent cervical lymphadenopathy and polymorphous rash, had higher neutrophil percentage, N-terminal fragment of pro-brain natriuretic peptide, and alanine aminotransferase levels, and a higher incidence of coronary artery lesions than patients without splenomegaly.


Splenomegaly belongs to incomplete Kawasaki disease patients mainly with a higher incidence of coronary artery lesions than that of patients without it.


Corresponding author

Author for correspondence: S.H. Kim, MD, PhD, Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Paryong-ro, Masanhoewon-gu, Changwon 51353, Republic of Korea. Tel: 82-55-233-5932; Fax: 82-55-233-5329; E-mail:


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Cite this article: Kang DW, Kim SH. (2019) Clinical aspects of splenomegaly as a possible predictive factor of coronary artery changes in Kawasaki disease. Cardiology in the Young29: 297–302. doi: 10.1017/S1047951118002238



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1. Kawasaki, T, Kosaki, F, Okawa, S, Shigematsu, I, Yanagawa, H. A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics 1974; 54: 271276.
2. McCrindle, BW, Rowley, AH, Newburger, JW, et al. American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association. Circulation 2017; 135: e927e999.
3. Suddleson, EA, Reid, B, Woolley, MM, Takahashi, M. Hydrops of the gallbladder associated with Kawasaki syndrome. J Pediatr Surg 1987; 22: 956959.
4. McGahan, JP, Phillips, HE, Cox, KL. Sonography of the normal pediatric gallbladder and biliary tract. Radiology 1982; 144: 873875.10.1148/radiology.144.4.7111740
5. Chen, CJ, Huang, FC, Tiao, MM, et al. Sonographic gallbladder abnormality is associated with intravenous immunoglobulin resistance in Kawasaki disease. Scientific World Journal 2012; 2012: 485758.
6. Maurer, K, Unsinn, KM, Waltner-Romen, M, Geiger, R, Gassner, I. Segmental bowel-wall thickening on abdominal ultrasonography: an additional diagnostic sign in Kawasaki disease. Pediatr Radiol 2008; 38: 10131016.
7. Ohshio, G, Furukawa, F, Fujiwara, H, Hamashima, Y. Hepatomegaly and splenomegaly in Kawasaki disease. Pediatr Pathol 1985; 4: 257264.10.3109/15513818509026899
8. Cunha, BA, Pherez, FM, Alexiadis, V, Gagos, M, Strollo, S. Adult Kawasaki’s disease with myocarditis, splenomegaly, and highly elevated serum ferritin levels. Heart Lung 2010; 39: 164172.
9. DeSanctis, JT, Connoly, SA, Bramson, RT. Effect of patient position on sonographically measured renal length in neonates, infants and children. AJR Am J Roentgenol 1998; 170: 13811383.
10. Rosenberg, HK, Markowitz, RI, Kolberg, H, Park, C, Hubbard, A, Bellah, RD. Normal splenic size in infants and children: sonographic measurements. AJR Am J Roentgenol 1991; 157: 119121.
11. Kim, GB, Han, JW, Park, YW, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009–2011. Pediatr Infect Dis J 2014; 33: 2427.
12. Kato, H, Sugimura, T, Akagi, T, et al. Long-term consequences of Kawasaki disease: a 10- to 21-year follow-up study of 594 patients. Circulation 1996; 94: 13791385.10.1161/01.CIR.94.6.1379
13. Parsa, SA, Khaheshi, I, Paydary, K, Haybar, H. Acute myocardial infarction in a 35-year-old man with coronary artery aneurysm most probably caused by Kawasaki disease. Asian Pac J Trop Biomed 2014; 4 (Suppl 1): S5052.
14. Yun, SH, Yang, NR, Park, SA. Associated symptoms of Kawasaki disease. Korean Circ J 2011; 41: 394398.
15. Chung, CJ, Rayder, S, Meyers, W, Long, J. Kawasaki disease presenting as focal colitis. Pediatr Radiol 1996; 26: 455457.
16. Magilavy, DB, Speert, DP, Silver, TM, Sullivan, DB. Mucocutaneous lymph node syndrome: report of two cases complicated by gallbladder hydrops and diagnosed by ultrasound. Pediatrics 1978; 61: 699702.
17. Suddleson, EA, Reid, B, Woolley, MM, Takahashi, M. Hydrops of the gallbladder associated with Kawasaki syndrome. J Pediatr Surg 1987; 22: 956959.
18. Kim, HK, Kim, HG, Cho, SJ, Hong, YM, Sohn, S, Yoo, ES, Chung, WS, Ryu, KH. Clinical characteristics of hemophagocytic lymphohistiocytosis related to Kawasaki disease. Pediatr Hematol Oncol 2011; 28: 230236.
19. Doğan, V, Karaaslan, E, Özer, S, Gümüşer, R, Yılmaz, R. Hemophagocytosis in the acute phase of fatal Kawasaki disease in a 4 month-old girl. Balkan Med J 2016; 33: 470472.
20. Palazzi, DL, McClain, KL, Kaplan, SL. Hemophagocytic syndrome after Kawasaki disease. Pediatr Infect Dis J 2003; 22: 663666.
21. Titze, U, Janka, G, Schneider, EM, Prall, F, Haffner, D, Classen, CF. Hemophagocytic lymphohistiocytosis and Kawasaki disease: combined manifestation and differential diagnosis. Pediatr Blood Cancer 2009; 53: 493495.10.1002/pbc.22098
22. Matsubara, T, Ichiyama, T, Furukawa, S. Immunological profile of peripheral blood lymphocytes and monocytes/macrophages in Kawasaki disease. Clin Exp Immunol 2005; 141: 381387.
23. Brogan, PA, Shah, V, Clarke, LA, Dillon, MJ, Klein, N. T cell activation profiles in Kawasaki syndrome. Clin Exp Immunol 2008; 151: 267274.



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