Four immunocompetent patients with pulmonary cryptococcosis were diagnosed by either fine needle aspiration (FNA) cytology or sputum cytology over five years. The pulmonary manifestations were subpleural nodules and pneumonic infiltrates. Percutaneous transthoracic FNA under real-time ultrasound guidance for the subpleural nodules was used, as were periodic acid-Schiff stain and Liu's stain. Three of the patients with no evidence of extrapulmonary involvement received no antifungal therapy, and spontaneous resolution of the infection without recurrence was noted during follow-up. The role of cytology in the diagnosis of this unique and often-unsuspected subset of pulmonary fungal disease is emphasized.