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We herein describe the first pediatric case of an internal mammary artery (IMA) aneurysm caused by a median sternotomy. He was a 2-year-old with tricuspid atresia who underwent an extracardiac conduit Fontan procedure. On the 36th postoperative day, an asymptomatic left IMA aneurysm was detected via contrast computed tomography, which was successfully treated with coil embolization. The patient had no underlying disease such as vasculitis, connective tissue disease, or other hereditary diseases, and there were no episodes of infection or hypertension before or after the onset of the IMA aneurysm. Because the left IMA ran medially to the periphery and was in a vulnerable position during median sternotomy, we considered the IMA aneurysm was caused by the median sternotomy. We pediatric cardiologists should be aware that IMA aneurysms can occur in pediatric cardiac surgery, and we should be proactive in performing postoperative imaging studies in cases where the preoperative internal thoracic artery runs medially toward the periphery. Internal mammary artery (IMA) aneurysm is a rare vascular disease, especially in children. One-third of adult IMA aneurysms have been reported to be caused by sternotomy, but not in children. We report the first pediatric case of an IMA aneurysm caused by sternotomy. We should recognize that there is a potential risk of IMA aneurysms in pediatric cardiac surgery as well. [ABSTRACT FROM AUTHOR]

Objective: To examine the characteristics of patients with Kawasaki disease (KD) presenting with only fever and cervical lymphadenopathy at admission. Study design: The laboratory and clinical findings of patients with definite KD presenting with only fever and cervical lymphadenopathy at admission (KDiL) were compared with those of all other patients with KD. Results: Sixteen patients with KDiL (8.6%) and 171 patients without KDiL were examined. The patients with KDiL were significantly older (KDiL/non-KDiL: 4.9±2.5/2.2±1.9 years) and admitted earlier (3.0±1.2/3.9±1.3 days of illness) than the patients without KDiL. They also showed significantly elevated white blood cell counts and C-reactive protein levels. Patients with KDiL were treated with the same dose of intravenous immunoglobulin as the patients without KDiL but were treated slightly later and had significantly higher frequency of additional intravenous immunoglobulin treatment (38%/10%) and coronary artery abnormalities (25%/5%). After adjustment for age, white blood cell count, and day of illness at admission or first intravenous immunoglobulin administration, the presence of KDiL significantly increased the risk of being a nonresponder to IVIG treatment or development of a coronary artery abnormality. Conclusions: KDiL indicates a severe form of KD associated with increased risks of additional intravenous immunoglobulin treatment and coronary artery abnormalities. Patients with KDiL may require heightened surveillance and more aggressive treatment. [Copyright &y& Elsevier]