Congestive Heart Failure Masquerading as Primary Pulmonary Disease

Patients with congestive heart failure, particularly when it is chronic and insidious, may not have the typical signs of progressive dyspnea, cough, orthopnea, paroxysmal nocturnal dyspnea, or edema with weight gain. In addition, the roentgenographic findings may be atypical. Thus, the combination of atypical clinical and roentgenographic findings and the absence of positive physical findings such as rales and cardiac gallop may mislead the clinician from the correct diagnosis of congestive heart failure. Eight patients with congestive heart failure had their conditions originally diagnosed as primary pulmonary disease. The pulmonary diagnoses included diffuse pulmonary fibrosis, asthmatic bronchitis, diffuse pulmonary infiltrate of undetermined cause, pneumonitis, tumor, hilar mass, and emphysema. In such patients, the clinician must be alert for the possibility of congestive heart failure, particularly in elderly patients or patients with a history of coronary artery disease or valvular heart disease. The response to therapy for heart failure may be the best means of differentiating the patient with primary pulmonary disease from the one with congestive heart failure.

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				B. K. Gehlbach and E. Geppert The Pulmonary Manifestations of Left Heart Failure Chest, February 1, 2004; 125(2): 669 - 682. [Abstract] [Full Text] [PDF]