ABSTRACT
Various invasive and non-invasive imaging techniques have been used for the diagnosis of coronary artery disease. Despite several limitations, coronary CTA may soon emerge as the initial diagnostic modality of choice for patients with suspected coronary artery disease. However, in routine clinical practice, the role of coronary CTA is not clearly defined even though promising diagnostic accuracy has been demonstrated compared with that of the other non-invasive tests. Herein, we suggest a new paradigm for coronary CTA as an emerging diagnostic tool in routine clinical practice on the basis of our experience and published data.
Subject(s)
Humans , Angiography , Coronary Artery Disease , DiagnosisABSTRACT
Acute sensorineural hearing loss is unusual as initial manifestations in a child with acute lymphoblastic leukemia (ALL), even though facial or oculomotor nerve palsy as early finding of leukemia was reported. The pathology of sensorineural hearing loss in leukemia showed as leukemic cell infiltration, hemorrhage, infection, and local ischemia due to hyperviscosity. A 12-year-old boy with ALL was admitted due to multiple cervical lymphadenopathy with left sided sensorineural deafness. He complained gross hematuria and purpura on whole body. His initial complete blood cell counts were hemoglobin 11.9 g/dL, hematocrit 34.3%, white blood cells 164,000/muL (segmented neutrophils 3%, lymphocytes 11%, monocytes 2%, immature blast 84%), and platelet 28,000/muL. Pure tone audiogram revealed profound sensorineural hearing loss of the left ear at all frequencies. His brain MRI showed no definite abnormal findings without hemorrhage or infarction in inner ear or temporal lobe. He received induction chemotherapy and total 4 times of transtympanic steroid injection with 1 week interval. His hearing power at complete remission was more improved than admission, but not completely recovered until 5 months. We proposed that hearing impairment might be an initial manifestation in acute leukemia with hyperleukocytosis.