Pulmonary radiological features of 27 patients with a diagnosis of hepatoma were reviewed and compared with 64 controls. Coin shadows, nodular, lymphangitic or hilar node metastases were observed in 50% of the hepatoma cases. Other radiological pulmonary findings in hepatoma included statistically significant elevation of the right hemidiaphragm, double contour of the diaphragmatic silhouette and discoid atelectasis. Left hemidiaphragm changes may occur with left lobe involvement. Double contour of the crest of the diaphragm appeared to be specific and common in hepatoma in this African population. Doming of the diaphragm was not specific to hepatoma.