# Atrial Septal Defect Presenting as Fleischner's Sign in an Elderly Patient: A Case Report

## TL;DR

An elderly patient with an undiagnosed heart condition was found to have a hole in the heart due to a specific X-ray sign.

## Contribution

Highlights Fleischner’s sign as a rare but important indicator of undiagnosed ASD in elderly patients.

## Key findings

- Fleischner’s sign was observed in an elderly patient with an asymptomatic ASD.
- ASD in the elderly is often undiagnosed until detected via imaging signs like Fleischner’s.
- Physicians should consider congenital heart disease when seeing Fleischner’s sign in chest X-rays.

## Abstract

In the elderly, the most common congenital heart disease is secundum atrial septal defect (ASD). We present a case of an elderly patient with an incidental diagnosis of asymptomatic ASD, detected on a posteroanterior chest X-ray by Fleischner’s sign. Fleischner’s sign is defined as the radiographic finding of a prominent central pulmonary artery, suggesting pulmonary hypertension. This is rarely seen in ASD that remains undiagnosed until elderhood. Although congenital heart disease is relatively rare in the elderly, physicians should maintain a high index of suspicion when interpreting chest X-rays that exhibit the Fleischner’s sign in the hila of the lungs.