PURPOSE: To describe the radiologic findings in patients with primary bronchogenic carcinoma and pulmonary metastases at presentation. MATERIALS AND METHODS: A retrospective review of patients with bronchogenic carcinoma who at presentation had pulmonary metastases. RESULTS: Fourteen (52%) men and 13 (48%) women with a mean age of 60 years were identified. Adenocarcinoma was the most common histology (70%). The number of nodules varied, although 78% of patients had greater than 50 nodules. Nodules size ranged from 2 to 30 mm, but 82% of patients had nodules less than 10 mm in diameter. Mediastinal lymphadenopathy was seen in 41% of patients, and pleural disease in 44% of patients. Only 37% had radiologic evidence of extrathoracic disease, with bone metastases (30%) being the most common. CONCLUSION: Multiple pulmonary nodules may be the presenting thoracic manifestation of primary bronchogenic carcinoma, with patterns of metastases and survival rates similar to other stage IV patients.