Diagnostic Fleischner’s sign in atrial septal defect
Fleischner sigh is very rare in patients with ASD unless the defect remains undiagnosed till the elderly. For adulthood people with Fleischner sign, we should think about the possibility of congenital heart disease.

A 40-year-old woman with shortness of breath and chest tightness presented to the emergency department. Posteroanterior chest X-ray revealed a Fleischner sign in lung, suggesting a pulmonary hypertension. A subsequent transthoracic echocardiogram revealed an arterial septal defect (ASD) with a dilated right heart and a mean pulmonary pressure of 57 mmHg. Abdominal ultrasound showed widening of the hepatic veins to a maximum of about 1.2 cm.

Fleischner sign refers to a prominent central pulmonary artery that can be commonly caused either by pulmonary hypertension or by a distension of the vessel by a large pulmonary embolus involving 50% or more of the major pulmonary artery branches.1 Hepatic vein dilatation means that venous return is blocked and can be observed in patients with right heart insufficiency. Those findings are very rare in patient with secundum atrial septal defect unless the defect remains undiagnosed till the adulthood.

Source: https://onlinelibrary.wiley.com/doi/10.1002/ccr3.4485?af=R