VARIOUS systemic mycoses have been found usually so similar to tuberculosis, clinically and pathologically, that they could be positively diagnosed only by identification of the organism. They have so much in common that mycosis in general, not a specific one, is often to be suspected. Since all infections cannot have exhaustive bacteriologic study, early recognition of mycotic disease will depend on alertness to suspicious but not distinctive features which single out cases for such investigation. The comparatively few roentgen studies have also demonstrated nothing pathognomonic. These diseases may be thought too rare for routine consideration in roentgen diagnosis. There is persistent belief, however, that many pass unrecognized. Also, most reported cures have followed early diagnosis as local infections, primary pulmonary attacks, or early in the metastatic stage. The best, if not the only, opportunity for cure is before massive infection, profuse metastases, or chronic attenuated but intractable widespread involvement. Much is at stake in early diagnosis which is difficult and useful. Intrathoracic involvement is usually present, and a pulmonary onset is frequent. Roentgen manifestations, however inconclusive, may be of service if they promote bacteriologic study. It may then be justifiable to attempt this survey, comparing coccidioidal granuloma, of which mycosis alone we have a significant number of cases, with tuberculosis and other mycotic diseases, through our own few cases and through the literature. Unfortunately, roentgen detail is not stressed in the literature. Also, these diseases appear almost as varied in roentgen manifestations as tuberculosis itself. Significant predilections and associations only may be hoped for. A description of the pathogenic fungi is not necessary here; classifications and nomenclatures disagree. Differing strains and pleomorphic forms occur. Blastomyces, actinomyces, aspergilla, and monilias are genera, the individual species of which differ structurally, culturally, and in pathogenesis. These groups, however, may be considered as entities until more standardized botanical classification and adequate clinical material justify closer distinction. Subject to differing opinions, identification of the organisms is available from experienced bacteriologists and mycologists. Coccidioidal Granuloma Primary infection is cutaneous, pulmonary, or rarely, oropharyngeal. The digestive tract is practically immune. Pulmonary onsets are very common; their full proportion is not known because they may subside and become significant only by later metastatic manifestations. The disease is essentially granulomatous, its basic lesion a tubercle, resembling that of tuberculosis. Lymph glands are selectively involved. Abscess is common. The lesions are quite invasive, but blood vascular metastatic dissemination is more prominent than spread by contiguity.