A retrospective analysis was done of 120 consecutive patients with life-threatening hemoptysis (greater than 200 ml of discharge per 24 hours) cared for between 1983 and 1990 at our institution. Seventy-nine percent of the patients (95/120) had hemoptysis exceeding 500 ml/24 hr. Inflammatory lung disease was the underlying cause in at least 85% of cases (n = 103); and of these, pulmonary tuberculosis was the primary diagnosis in 85% (88/103). Fifty-two patients (43%) had had a prior episode of massive hemoptysis, usually within 3 months of their admission. Urgent examination with rigid endoscope in 97 patients (81%) localized the bleeding in only 42 (43%). The overall hospital mortality rate was 10% (12/120) and was similar for those having pulmonary resection (7.1%, 3/42), and those assisted medically (11.5%, 9/78) (p = not significant). However, of these hospital survivors on whom 6-month follow-up was available, 36.4% (20/55) of those with medical management and none (0/39) (p < 0.001) of those with surgical management had recurrent massive hemoptysis. Forty-five percent of these cases were fatal. Current management of massive hemoptysis has resulted in improved hospital outcome. However, the high risk of recurrent and often fatal hemoptysis mandates the definitive management of the bronchial arteries before discharge from the hospital. Recent reports suggest that percutaneous embolization may be effective in nonsurgical candidates.