The diagnostic pathway for coronary artery disease (CAD) is actively transitioning toward noninvasive risk stratification. This review contrasts Coronary Computed Tomography Angiography (CCTA) with Invasive Coronary Angiography (ICA) to clarify their respective roles and physical limitations in modern cardiovascular care.

Eosinophilic pleural effusion (EPE) is a rare pleural disorder characterized by a significant proportion of eosinophils in the pleural fluid. Its etiologies are diverse and include malignancy, infections, pulmonary embolism, drug-induced reactions, and parasitic diseases. Pleural involvement in toxocariasis is rare and may pose diagnostic challenges, particularly in tuberculosis-endemic regions. We report the case of a 67-year-old male farmer from a rural area who presented with progressive dyspnea, right-sided chest pain, fever, and general deterioration. Physical examination revealed signs consistent with a right pleural effusion. Laboratory investigations showed leukocytosis with peripheral eosinophilia (1,040/μL; reference range: 0-500 cells/μL) and elevated inflammatory markers. Chest imaging demonstrated a loculated right pleural effusion. Pleural fluid analysis revealed an exudative effusion with marked eosinophilia. Microbiological investigations, including bacterial cultures and acid-fast bacilli testing, were negative, although pleural tuberculosis could not be completely excluded based on microbiology alone. Cytological examination showed no malignant cells; however, a single negative cytology does not fully exclude malignancy. Despite pleural drainage and empirical broad-spectrum antibiotic therapy, no sustained clinical improvement was observed. Further investigations revealed elevated anti-Toxocara canis IgG levels in both serum and pleural fluid, confirmed by Western blot analysis. Given the clinical context of EPE, negative microbiological workup, and persistent eosinophilia, these findings supported a diagnosis of pleural toxocariasis, although seropositivity may also reflect prior exposure. Treatment with albendazole was followed by clinical and radiological improvement, with resolution of eosinophilia and marked regression of the pleural effusion. This case highlights the importance of including parasitic infections, particularly toxocariasis, in the differential diagnosis of EPE. In tuberculosis-endemic regions, careful evaluation is required to avoid premature diagnostic closure. Albendazole therapy may be associated with clinical improvement in selected cases; however, causality cannot be definitively established from a single case report.

Takotsubo syndrome (TTS) is a transient stress-induced cardiomyopathy. It typically occurs following emotional or physical stressors. Many variants are described, the most common being the apical ballooning; however, atypical variants such as focal TTS are rare and can mimic acute coronary syndromes. We report the case of a 49-year-old woman presenting with chest pain and marked troponin elevation who underwent coronary angiography with left ventriculography demonstrating non-obstructive coronary arteries, inferior apical hypokinesis, and a subtle distal left anterior descending artery abnormality. Serial troponin testing confirmed a peak high-sensitivity troponin of 1,967 ng/L. In the context of emotional stress, absence of obstructive coronary disease, and atypical angiographic features inconsistent with plaque rupture or spontaneous coronary artery dissection, a diagnosis of focal TTS was considered most consistent. This case highlights the diagnostic challenges in identifying focal variants of Takotsubo cardiomyopathy.

Myeloid sarcoma is a rare extramedullary malignant tumor composed of immature myeloid cells and is frequently associated with acute myeloid leukemia. Isolated mediastinal involvement is exceedingly uncommon and often poses a significant diagnostic challenge because of nonspecific clinical and imaging features, frequently leading to misdiagnosis as lymphoma. We report posterior mediastinal myeloid sarcoma in a 39-year-old man who presented with back pain and chest discomfort. Conventional contrast-enhanced computed tomography demonstrated a homogeneous posterior mediastinal soft-tissue mass encasing the descending aorta, and lymphoma was initially suspected. Contrast-enhanced dual-energy computed tomography demonstrated low iodine uptake and a relatively flat spectral attenuation curve, providing supplementary information for lesion characterization and imaging-pathology correlation. The final diagnosis was established after surgical resection by histopathological and immunohistochemical examination. This case suggests that dual-energy computed tomography may be a useful adjunctive imaging tool in selected mediastinal tumors; however, its findings should be interpreted cautiously and cannot replace histopathological, immunohistochemical, and hematological evaluation.

SCD is a prevalent genetic disorder marked by chronic complications that impact quality of life and survival. Affecting approximately 100 000 individuals in the United States and millions globally, SCD results from a mutation in the β-globin gene, leading to sickle-shaped red blood cells and subsequent vaso-occlusive episodes, hemolysis, and multiorgan damage. Despite advancements such as newborn screening and disease-modifying therapies, individuals with SCD continue to face significant long-term challenges. This review focuses on the major long-term complications of SCD, including chronic pain, mental health diagnoses, neurological deficits, infection, alloimmunization, cardiopulmonary complications, and reproductive health concerns. Pain, often a hallmark of SCD, significantly affects quality of life and requires an individualized approach to management. Depression and anxiety are prevalent and impact both psychosocial well-being and disease outcomes. Neurological complications, including stroke and cognitive deficits, pose substantial risks and require ongoing monitoring. Reproductive health concerns, such as fertility and pregnancy complications, demand careful management. Alloimmunization, a potential consequence of transfusion exposure transfusion exposure, complicates future transfusion therapy and increases the risk of delayed hemolytic transfusion reactions. Cardiopulmonary complications, including pulmonary hypertension and restrictive lung disease secondary to recurrent acute chest syndrome, are associated with increased morbidity and warrant early recognition and monitoring. This review aims to bridge the knowledge gap for general pediatricians by providing comprehensive insights into these long-term complications and offering strategies for effective management. Understanding these aspects is essential for improving patient outcomes and ensuring that pediatricians can provide informed, empathetic, and proactive care for children with SCD.