Key result
Crochetage sign on ECG helps identify underlying patent foramen ovale in young neurologic patient.
Why the study?
Subtle electrocardiographic findings such as the crochetage sign may strongly suggest underlying interatrial septal abnormalities including patent foramen ovale, but their diagnostic value is underrecognized.
Case Report (n=1)
The crochetage sign (notching at the apex of the R wave in inferior limb leads) on a standard 12-lead ECG is a specific, subtle marker of interatrial septal abnormalities that can guide diagnostic evaluation for structural heart disease.
May prompt ECG scrutiny for crochetage sign in young neurologic patients; hypothesis-generating and leaves open validation for routine use.
INTRODUCTION: A young man was hospitalized for evaluation of acute neurologic symptoms. Initial diagnostic testing was unrevealing; however, a 12-lead electrocardiogram demonstrated notching at the apex of the R wave in the inferior leads, consistent with the crochetage sign. CASE PRESENTATION: Further cardiac evaluation was pursued. Transthoracic echocardiography identified an atrial septal aneurysm with evidence of interatrial shunting on agitated saline contrast study, consistent with a patent foramen ovale. DISCUSSION: This case highlights the diagnostic value of careful electrocardiographic interpretation and demonstrates how subtle electrocardiogram findings may strongly suggest underlying structural heart disease.
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Patel et al. (2026) conducted a case report in Patent Foramen Ovale (n=1). Crochetage sign on electrocardiography was evaluated on Diagnosis of interatrial septal abnormality (Patent Foramen Ovale). The presence of a crochetage sign on electrocardiography in a young man with neurologic symptoms prompted targeted evaluation and successfully identified an underlying patent foramen ovale.
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