Diagonal Earlobe Crease, a Marker of Coronary Artery Disease: A Case Report on Frank's Sign.

Araz Baboujian,Prema Bezwada,Cesar Ayala-Rodriguez

doi:10.7759/cureus.4219

Abstract

There are various physical signs that can be used as a reliable tool to diagnose the subclinical stages of atherosclerosis, including corneal arcus, xanthelasma, and diagonal earlobe crease (DELC) or “Frank's sign”. Bilateral diagonal earlobe crease has been positively correlated with coronary artery disease (CAD) and peripheral vascular disease (PVD). The presence of DELC has been identified as an independent variable for CAD. The exact etiology is unknown and the association between the presence of DELC and coronary artery disease (CAD) still remains controversial. We report a case of a patient with bilateral DELC who was found to have remarkable non-occlusive CAD on diagnostic coronary angiography.

Highlights

Frank's sign is a diagonal earlobe crease (DELC) which is a wrinkle that extends 45° backward from the tragus to the auricle; it is hypothesized to be a predictor of atherosclerotic disease
This sign has been positively correlated with coronary artery disease (CAD) and peripheral vascular disease (PVD) [1,2,3] and was classified as an independent variable for CAD [4,5]
An 83-year-old male ex-smoker presented with progressive worsening of shortness of breath and dry cough for three days. His past medical history was significant for sick sinus syndrome, status-post pacemaker placement in 2014, heart failure with a reduced ejection fraction (HFrEF), hypertension, diabetes mellitus with dermopathy, rectal cancer status-post colostomy, chronic obstructive pulmonary disease (COPD), benign prostatic hypertrophy, and gout

Summary

Introduction

Frank's sign is a diagonal earlobe crease (DELC) which is a wrinkle that extends 45° backward from the tragus to the auricle; it is hypothesized to be a predictor of atherosclerotic disease. An 83-year-old male ex-smoker presented with progressive worsening of shortness of breath and dry cough for three days His past medical history was significant for sick sinus syndrome, status-post pacemaker placement in 2014, heart failure with a reduced ejection fraction (HFrEF), hypertension, diabetes mellitus with dermopathy, rectal cancer status-post colostomy, chronic obstructive pulmonary disease (COPD), benign prostatic hypertrophy, and gout. A transthoracic echocardiogram revealed an ejection fraction of 35% - 40%, Grade 1 left ventricular diastolic dysfunction, and abnormal septal motion consistent with a conduction abnormality He subsequently underwent a coronary angiogram which revealed disease of the circumflex artery with a 30% lesion in the proximal segment, a 50% lesion in the distal segment, and a 50% lesion in the proximal segment of the obtuse marginal artery focal lesion) (Figure 2). Panels A and B: Coronary angiogram showing disease of the circumflex artery - 30% lesion in the proximal segment (arrow 1), a 50% lesion in the distal segment (arrow 2), and a 50% lesion in the proximal segment of the obtuse marginal artery (arrow 3)

Discussion

Conclusions

Disclosures

Findings

Frank ST