{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T22:11:05Z","timestamp":1757542265757,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,7,16]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>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\u2009cm 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.<\/jats:p>","DOI":"10.1136\/bcr-2021-244180","type":"journal-article","created":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T11:30:07Z","timestamp":1627385407000},"page":"e244180","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Atrial septal defect with Crochetage sign presenting with pulmonary artery thrombosis"],"prefix":"10.1136","volume":"14","author":[{"given":"Neerusha","family":"Kaisbain","sequence":"first","affiliation":[{"name":"Department of Medicine, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5943-7045","authenticated-orcid":false,"given":"Wei Juan","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia"},{"name":"Cardiology, Institut Jantung Negara, Kuala Lumpur, Wilayah Persekutuan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8362-7295","authenticated-orcid":false,"given":"Heng Shee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,27]]},"reference":[{"key":"2025082804394507000_14.7.e244180.1","doi-asserted-by":"crossref","first-page":"331","DOI":"10.5603\/KP.a2014.0240","article-title":"The importance of electrocardiographic findings in the diagnosis of atrial septal defect","volume":"73","author":"Bayar","year":"2015","journal-title":"Kardiol Pol"},{"key":"2025082804394507000_14.7.e244180.2","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1007\/s00246-018-1857-0","article-title":"The significance 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septal defect with massive pulmonary embolism: a diagnostic dilemma","volume":"19","author":"Dinesh Kumar","year":"2016","journal-title":"Ann Card Anaesth"},{"key":"2025082804394507000_14.7.e244180.11","first-page":"217","article-title":"Intracardiac thrombi, pulmonary embolism, atrial septal defect, and polycythemia vera","volume":"24","author":"Tien-Yu","year":"2018","journal-title":"Acta Cardiologica Sinica"}],"container-title":["BMJ Case 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