Twenty-five Indochinese refugees with paragonimiasis were reviewed. Thirteen patients were diagnosed by ova identification in sputum specimens, but 12 patients were diagnosed by an elevated complement fixation titer in conjunction with clinical and epidemiologic criteria. Roentgenographic lesions included diffuse (44%) and segmental (24%) infiltrates, nodules (20%), and cavities (20%). The classic ring shadow was present in only 8%. Of note was the frequency of pleural effusions (48%), which were massive in 6 patients and the sole manifestation in 5. Although tuberculosis should always be excluded, work-up of pulmonary effusions and infiltrates in immigrants from Southeast Asia should include a serologic and microbiologic search for paragonimiasis.