Congestive heart failure, particularly when it is chronic and insidious, may not exhibit 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 misleading clinical and roentgenographic findings and the absence of positive physical findings such as rales and cardiac gallop may lead the clinician away from the correct diagnosis of congestive heart failure.
A series of cases of congestive heart failure is presented in which the original diagnosis was primary pulmonary disease. The pulmonary diagnoses included diffuse pulmonary fibrosis, asthmatic, bronchitis,