JOURNAL OF COMMUNITY HOSPITAL INTERNAL MEDICINE PERSPECTIVES
æ
CLINICAL IMAGING
Frank’s sign: a potential predictor of cardiovascular disease Shoaib Bilal Fareedy, Resident Physician*, Ranjan Pathak, Resident Physician, Ahmed Salman, Resident Physician and Richard Alweis, Programe Director Department of Internal Medicine, Reading Hospital, Reading, PA, USA *Correspondence to: Shoaib Bilal Fareedy, 1650 Penn Avenue, Apt D4, Wyomissing, PA 19610, USA, Email:
[email protected] Received: 4 December 2014; Accepted: 19 January 2015; Published: 1 April 2015
43-year-old male with a history of hypertension and chronic kidney disease, stage 3, presented with chief complaints of fever, chills, lower extremity redness, and pain. On examination, he was hemodynamically stable with findings consistent with bilateral lower extremity cellulitis. A wrinkle-like line extending in the earlobes extending backward from the tragus at an angle of 458 was observed bilaterally. Laboratory evaluation did not reveal hyperlipidemia, but on further questioning he
A
gave history suggestive of angina. After resolution of the cellulitis, the patient was discharged home with instructions to follow up with his primary care doctor for cardiac work up. Diagonal ear lobe crease (also known as Frank’s sign) has been traditionally considered as a surrogate marker of coronary and carotid artery atherosclerosis (1). It was first associated with coronary artery disease in an article by Frank published in 1973 (2). Alternative hypotheses such as coincident association between aging changes and atherosclerosis, anatomic peculiarity, or a result of a particular way of sleeping have also been proposed for diagonal ear lobe creases (3). Although controversies remain, a recent study by Shmilovich et al. found that it is associated not only with the presence of coronary atherosclerosis but also with its extent and severity (4). It has been postulated that ear lobe and myocardium are supplied by the same genetically originated end arterioles and thus share a common pathway (5). In conclusion, although controversies exist, the presence of diagonal ear lobe crease should prompt clinicians to evaluate patients for coronary or carotid atherosclerotic disease, especially when there are other concurrent risk factors for atherosclerosis.
References
The arrow points to Frank’s Sign, an oblique crease running from the tragus back towards the rear edge of the ear lobule.
1. Friedlander AH, Lo´pez-Lo´pez J, Velasco-Ortega E. Diagonal ear lobe crease and atherosclerosis: A review of the medical literature and dental implications. Med Oral Patol Oral Cir Bucal 2012; 17(1): e1539. 2. Frank ST. Ear-crease sign of coronary disease. N Engl J Med 1977; 297(5): 282.
Journal of Community Hospital Internal Medicine Perspectives 2015. # 2015 Shoaib Bilal Fareedy et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), permitting all noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Journal of Community Hospital Internal Medicine Perspectives 2015, 5: 26885 - http://dx.doi.org/10.3402/jchimp.v5.26885
1
(page number not for citation purpose)
Shoaib Bilal Fareedy et al.
3. Gutiu IA, Galet¸escu E, Gutiu LI, Ra˘ducu L. Diagonal earlobe crease: A coronary risk factor, a genetic marker of coronary heart disease, or a mere wrinkle. Ancient Greco-Roman evidence. Rom J Intern Med 1996; 34(34): 2718. 4. Shmilovich H, Cheng VY, Rajani R, Dey D, Tamarappoo BK, Nakazato R, et al. Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease deter-
mined by coronary computed tomography angiography. Am J Cardiol 2012; 109(9): 12837. 5. Evrengu¨l H, Dursunog˘lu D, Kaftan A, Zoghi M, Tanriverdi H, Zungur M, et al. Bilateral diagonal earlobe crease and coronary artery disease: A significant association. Dermatol Basel Switz 2004; 209(4): 2715.
2 Citation: Journal of Community Hospital Internal Medicine Perspectives 2015, 5: 26885 - http://dx.doi.org/10.3402/jchimp.v5.26885 (page number not for citation purpose)
