Pulmonary involvement in inflammatory bowel disease is rare and can present as airway, interstitial, or pleural lesions. Lung symptoms usually develop after the onset of bowel disease but occasionally may be the initial manifestation. Pulmonary complications of inflammatory bowel disease include chronic bronchitis, bronchiectasis, bronchiolitis, serositis, necrobiotic nodules, and interstitial lung disease. Noncaseating granulomas may occasionally be observed in a lymphancitic distribution, including bronchi, and in parenchyma and in lung biopsies from patients with Crohn disease. Crohn disease and infection should be ruled out. Radiologic findings include multiple bilateral nodular opacities and thickening of the trachea and bronchial walls.