Pulmonary manifestations in 114 patients with at least two sputum cultures positive for M. intracellularis, no history of any kind of tuberculosis, and not other potential pathogen are described. Even with these stringent diagnostic criteria, seven patients had normal chest radiographs and another seven had reticulonodular-appearing disease without a definite focus of infection. In the other 100 patients, 92% had infiltrates in the apical and/or posterior segments of the upper lobes, and 88% had cavitary disease. The cavities were usually multiple and frequently measured over 4 cm. Scarring and volume loss were common, occurring to some degree in 70% of upper lobe foci. Pleural effusions were uncommon (5%) and usually small. Adenopathy was less common (4%) and usually occurred with upper lobe disease in younger patients. Most patients had some degree of endobronchial spread (81%). The radiographic characteristics of Mycobacterium intracellularis are not believed distinctive enought to differentiate it from Mycobacterium tuberculosis.