Massive hemoptysis may be defined as greater than 600 ml of blood loss from the lungs in 24 hours. The current mortality rate is approximately 13% and is related to drowning or suffocation rather than exsanguination. The most common cause, even nowadays is tuberculosis. Diagnosis and treatment typically include a chest x-ray and emergency bronchoscopy using a 10-mm rigid scope. Treatment options must be guided by the clinical situation and the findings. Bronchoscopy under general anesthesia is performed and bleeding is controlled so as to prevent soiling the contralateral (uninvolved) lung. Conservative management may consist simply of bronchoscopy, clearing the airway of blood, cough suppression, and bed rest. Patients with cystic fibrosis may require tamponade using a balloon catheter. Patients with aspergilloma fungus balls are at high risk for fatal hemorrhage and should be aggressively treated and undergo resection when possible. Angiographic catheterization for massive hemoptysis may be considered for patients with hemoptysis and inability to localize a bleeding site. The risk of quadriplegia must be considered in light of the overall patient condition. Pneumon 2006, 19(3):192-201.