Bleomycin has been associated with pulmonary toxicity which is typically manifested as an interstitial pneumonitis resulting in fine, diffuse reticular or reticulomicronodular infiltrates. Attention is drawn to an additional radiologic appearance where discrete pulmonary nodules are seen and representative of bleomycin-induced change. The pitfalls of interpreting such changes as toxic effects versus metastatic disease and proposed mechanisms of bleomycin pulmonary toxicity are discussed.