A high-quality chest radiograph and a timely, accurate report are often impossible in the tropics. Rationale matching of service to need, enthusiasm, commitment, and exploitation of information technology all go some way toward enabling patients with pulmonary disease to be imaged. The radiologic findings reflect the high preponderance of infectious disease. TB, HIV, and TB modified by HIV may be "routine" features in some parts of the tropics. Elsewhere, infestation with ameba, hydatid, and strongyloidosis, paragonimiasis, and melioidosis accounts for radiographic signs. The key is to have these conditions firmly in mind when reading tropical radiographs and be aware that the pattern of disease may be different between the patient from the tropics and the more familiar patient from downtown New York.