1. Atrial septal defect with Crochetage sign presenting with pulmonary artery thrombosis
- Author
-
Heng Shee Kim, Wei Juan Lim, and Neerusha Kaisbain
- Subjects
Adult ,Male ,medicine.medical_specialty ,Heart disease ,Bundle-Branch Block ,Diagnostic Specificity ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Heart Septal Defects, Atrial ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Internal medicine ,mental disorders ,medicine ,Humans ,cardiovascular diseases ,Pulmonary thrombosis ,Venous Thrombosis ,business.industry ,Pulmonary artery thrombosis ,General Medicine ,Middle Aged ,medicine.disease ,Shunt (medical) ,030228 respiratory system ,Strain pattern ,Ecg findings ,Eisenmenger syndrome ,Cardiology ,business - Abstract
Atrial septal defect (ASD) is the most common congenital heart disease observed in adult. Several ECG findings are considered sensitive for the diagnosis of ASD. We describe a 50 years old man who displayed Crochetage sign, incomplete right bundle branch block (IRBBB) and right ventricular strain pattern on ECG. Crochetage sign is highly specific for ASD and it correlates with shunt severity. The diagnostic specificity for ASD increases if the R waves have both Crochetage patterns and IRBBB. It is important not to confuse Crochetage signs with IRBBB abnormalities on ECG. Our patient was ultimately diagnosed with a large ASD measuring 3 cm with bidirectional shunt and concomitant pulmonary thrombosis. This illustrates that high suspicion of the ASD with the use of good-old ECG signs remains relevant in this modern era. This also reminds us that patients with Eisenmenger syndrome are at higher risk for pulmonary thrombosis.
- Published
- 2023