OBJECTIVE To study the clinical features of pulmonary Wegener's granulomatosis. METHODS The data of 20 patients with Wegener's granulomatosis diagnosed during the last 20 years were retrospectively analyzed. RESULTS (1) Twelve patients (60%) with Wegener's granulomatosis presented with symptoms of respiratory system including cough, purulent sputum, bloody sputum, hemoptysis or dyspnea. In 5 of the 12 patients, the pulmonary symptoms presented as the initial manifestations. (2) Chest radiography demonstrated that Wegener's granulomatosis could involve multiple lung fields, either unilateral or bilateral in the lung lobes, but bilateral lung involvement (8/12) was more common. The lesions included nodules, masses, thick or thin wall cavities, or infiltrates. (3) Multiple biopsies for histologic study were done in 14 patients. CONCLUSIONS Wegener's granulomatosis has different radiographic manifestations and is difficult to differentiate from pulmonary abscess, tuberculosis, pneumonia or lung cancer. Repeated and multiple biopsies are essential to confirm the diagnosis.