Proximal portion of major coronary arteries can often be seen on echocardiography, while the distal regions can seldom be imaged. Coronary arteries are better seen if they are dilated, especially in those with aneurysms in Kawasaki disease. In this case proximal left coronary artery is mildly dilated, possibly because of underlying valvular lesions with left ventricular dilatation and hypertrophy. Ao: Aorta; LCA: left coronary artery; LA: left atrium; RVOT: right ventricular outflow tract. Coronary arteries are relatively easier to image in children, while in adults echo window is often not good enough for imaging coronary arteries by echocardiography. In some patients with renal failure, the images are good enough so that left anterior descending coronary artery can be imaged to long extent. Cases are on record in which all major coronary branches are well imaged on echo in those with renal failure. Probably the waterlogged thorax permits better transmission of ultrasound in these cases.