Peñaloza-Tranchesi sign secondary to ascending aortic aneurysm and not due to right atrium enlargement

Low QRS amplitude in V1, with relative three-to-fourfold or greater increase in V2, is considered an indirect sign of right atrium enlargement (Peñaloza-Tranchesi sign). We describe a patient with Peñaloza-Tranchesi sign caused by an ascending aortic aneurysm, with normalization of the QRS complex amplitude in V1 after aortic replacement.