Pulmonary resection, when possible, is the conventional treatment of massive hemoptysis. Alternatives include bronchial artery embolization, Fogarty catheter balloon tamponade, and pharmacologic approaches. We used endotracheal intubation and flexible bronchoscopy to locate the bleeding site in three of four patients with massive hemoptysis. These cases are used to review the etiology of massive hemoptysis and the usefulness of flexible bronchoscopy to localize the source of hemorrhage.