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The identification of coronary artery aneurysm (CAA) in the acute and chronic phase of the disease is of prime importance for assessing the likelihood of acute lesions and cardiovascular sequelae. Occasionally, recognition of distal coronary artery has been proven challenging by traditional echocardiography. Our purpose was to evaluate the clinical application of two-dimensional echocardiography (2DE) for detecting CAA caused by Kawasaki disease (KD) and compare with dual-source computed tomography (DSCT). A total of 24 patients with known KD and CAAs were studied by two imaging modalities, i.e., 2DE and DSCT; that is to say, the number, position, shape, and size of each CAA and its association with thrombus, were detected first from echocardiography and then compared with those obtained from DSCT performed on the same day. Meanwhile the diameters of all coronary segments were measured for each patient. Giant aneurysms (GAs) were detected in 5 patients, small and medium coronary aneurysms were identified in 19 patients. The 2DE and DSCT have the same results of proximal coronary artery, whereas conclusion of our comparison of coronary artery visualization indicated that DSCT provided more explicit distal coronary artery than 2DE. A mural thrombus could be clearly delineated in the GAs by DSCT. The 2DE has been demonstrated to be an accurate technique to quantify CAAs in KD. However, DSCT is superior to 2DE for distal coronary artery visualization. Therefore, a combination of echocardiography and DSCT can offer an overview of coronary artery anatomy. (Echocardiography 2011;28:1025-1034) [ABSTRACT FROM AUTHOR]