Kawasaki disease (KD) is a leading cause of non-atherosclerotic coronary artery aneurysms and, less commonly, peripheral artery aneurysms. We report an 81-year-old Japanese man from Hawaii with a history of an abdominal aortic aneurysm, bilateral iliac aneurysms, and an ambiguous right atrial cystic mass. The patient developed new-onset atrial fibrillation during lithotripsy. Angiography and magnetic resonance imaging revealed giant coronary artery aneurysms of the right coronary artery (RCA) and left anterior descending artery, and a thoracic aortic aneurysm. The RCA aneurysm was greater than 2 inches in diameter at the time of operation. Although we cannot confirm whether the patient had KD during childhood, this is the most likely diagnosis in the absence of a connective tissue disorder, systemic vasculitis, or atherosclerotic risk factors. This patient may represent the oldest case of KD, predating the earliest known case by more than 20 years. This case sheds light on the historical epidemiology of KD and its clinical course, especially regarding late vascular sequelae.