Acquired atherosclerotic aortopulmonary fistula presenting as new-onset congestive heart failure

A middle-aged patient with new-onset congestive heart failure, a loud precordial systolic murmur, and a widened mediastinum on chest radiography is described. Noninvasive studies in addition to the clinical examination suggested an unusual complication of atherosclerotic aortic disease, which was demonstrated at aortography and confirmed at surgery. This case stresses the importance of a careful bedside examination in addition to selective noninvasive studies in patients with new-onset or atypical congestive heart failure.