coronary arteries may be detected by echocardiography as early as days after the onset of fever and usually peaks or weeks into the course of the illness Coronary aneurysms in early KD usually occur in the proximal segments of the major coronary vessels; abnormalities that occur distally are almost always associated with proximal coronary dilatation Aneurysms may also occur in arteries outside the coronary system, most commonly the subclavian, brachial, axillary, iliac, or femoral vessels, and occasionally in the abdominal aorta and renal arteries It is reasonable to obtain advanced imaging studies in select patients, but they are not routinely indicated for diagnosis and management of acute illness Transesophageal echocardiography, computed tomographic angiography (CTA), and cardiac MRI can be useful in older patients if visualization of the coronary arteries with echocardiogram is not adequate Patients with CAA may require additional antithrombotic therapy beyond aspirin, and this is determined by the size of the coronary artery abnormality Patients with large/giant coronary aneurysms may require multiple antithrombotic medications, and should receive anticoagulation treatment in consultation with a cardiologist Myocardial Disease Myocardial infarction caused by thrombotic occlusion of an aneurysmal and/or stenotic coronary artery is the principal cause of death in KD Patients with giant CAA (Z score ≥10 or absolute dimension ≥8 mm) have the most serious long-term consequences Rarely, dilated and weakened coronary arteries may rupture Mortality due to KD has decreased from almost 2% to