During a ten-year study period, we evaluated 100 histologically-proven sarcoid patients for the development of aspergillomas. Serum precipitins against Aspergillus antigens were used to screen all patients regardless of sarcoid stage. Twelve patients had serum precipitins and were further investigated with tomography and serial serum precipitins testing. Ten of these 12 patients had aspergillomas and two patients died of massive hemoptysis. No aspergillomas occurred in stages I, II, or non-cystic stage III patients. All ten aspergillomas developed in the 19 stage III patients with cystic parenchymal damage. We believe that aspergillomas in sarcoidosis are not as rare as previously reported, but occur commonly in chronic cystic sarcoidosis. Additionally, we found serial testing for serum precipitins to be valuable both for the screening of cystic sarcoid patients for aspergillomas and for the management of this complication.