A serious and often fatal complication of heart-lung transplantation is the development of obliterative bronchiolitis (OB). Currently the screening for OB is based on symptoms, pulmonary function tests, and transbronchial biopsies. The chest radiographs are often normal with OB. Obliterative bronchiolitis produces luminal narrowing of both bronchioles and bronchi resulting in areas of peripheral consolidation and occasional bronchiectasis. We report a patient in whom a chest film was normal, an aerosol ventilation lung scan was abnormal while a perfusion study was mildly abnormal. Simultaneously, routine CT was essentially normal while high resolution CT with 1 mm thick sections was clearly abnormal and demonstrated areas of consolidation. These imaging modalities detected clear-cut abnormalities at a time when the patient was symptomatic but prior to the development of demonstrable abnormality on chest radiograph.