Purpose or Case Report: With increased use of CT and MR for coronary imaging in children, pediatric radiologists are more likely to encounter the unusual finding of dilated or aneurysmal coronary arteries. An understanding of the differential diagnoses and clinical associations is critical for accurate diagnosis and timely initiation of therapy. This educational exhibit begins with a discussion of diagnostic criteria and terminology for describing coronary dilation. The exhibit includes representative cases of the various causes of coronary artery dilation and aneurysms in children, including congenital abnormalities (coronary artery fistula, ALCAPA, ARCAPA), acute infection/inflammation (Kawasaki Disease, MIS-C), chronic immune-mediated disorders (Takayasu arteritis, polyarteritis nodosa), connective tissue diseases, and iatrogenic/acquired etiologies. Implications for surgical/interventional planning, particularly for congenital etiologies, are a key attribute of cross-sectional imaging. Imaging characteristics and clinical manifestations are discussed in the context of each case.
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