Case A 62-year-old Kang presented with recurrent small intermittent hemoptysis with low-grade fever 6 years ago, and was diagnosed with pulmonary tuberculosis and treated with the HREZ regimen for 6 months. After stopping the drug, an examination revealed a 3 cm x 4 cm cavity in the dorsal segment of his right lower lung. A few days ago, the patient suddenly gulped bright red sputum with a maximum volume of about 400 ml at a time. Three days ago, hemoptysis reoccurred, and hemoptysis of 300-800 ml per day was referred to the provincial chest hospital for further treatment in an emergency. After admission, while preventing asphyxia, anemia and water-electrolyte disorders were actively corrected, preoperative examination was improved, and fiberoptic bronchoscopy was applied to clarify that the bleeding originated from the dorsal segment of right lower lung. Surgical procedure 08:30 Intravenous compound anesthesia with transoral tracheal double-lumen tube intubation. 09:00 Sterilization and sterile treatment sheet were laid, and the chest was entered through the right sixth intercostal space. 09:15 Exploration revealed a 5 cm × 5 cm × 4 cm mass in the dorsal segment of the right lower lung and dense adhesions to the lateral chest wall. Scattered foci of hard nodules of varying sizes were found in the basal low segment of the right lower lung. 09:20 The right main pulmonary fissure and the right lower pulmonary ligament were opened and the right lower pulmonary artery and vein were treated. Free the right lower pulmonary bronchus for resection. 10:50 Flush the chest cavity, stop the bleeding, place a chest drain, and close the chest. 11:00 Clear, extubate, and send the patient back to the intensive care unit. Concept and etiology of hemoptysis: hemoptysis is defined as bleeding from any part of the body below the larynx that is expelled through the oral cavity. Macrohemoptysis is diagnosed when the cumulative volume of hemoptysis in 24 hours is >600 ml or a single hemoptysis is >300 ml. The more common causes of hemoptysis include tuberculous cavity, bronchiectasis, fungal infection, pulmonary abscess, and pulmonary isolation disease. The etiology is not difficult to diagnose based on the patient’s history, physical signs and dynamic changes in the chest x-ray. Most of the bleeding in patients with hemoptysis comes from the bronchial arteries or the side branches of the arteries of the body circulation adjacent to the chest wall, often due to high pressure and aggressive bleeding, which makes medical treatment difficult to be effective. We believe that surgical treatment should be preferred as long as the patient is physically able and the lesion is limited. Preoperative preparation: In addition to timely hemostasis and etiologic treatment, the preoperative preparation of patients with hemoptysis is also important for the prevention of asphyxia, correction of hemorrhagic shock and water-electrolyte disturbances. There is a wide variety of clinical hemostatic drugs, but the rapid and effective ones are still mainly posterior pituitary hormone, which can be used first if there are no contraindications. This drug can play a hemostatic role by strongly promoting systemic vasoconstriction, which is especially suitable for emergency treatment of ruptured blood vessels. Hemagglutinin is a new type of hemostatic drug, which can promote platelet aggregation at the bleeding site and act as a prothrombin-like enzyme. For those who do not respond well to drugs and have signs of asphyxia, bronchial artery embolization can be used for further hemostasis. It has been reported in the literature that the direct hemostasis rate can reach about 85%, which is significantly better than the medical treatment alone. Active hemostatic treatment can not only prevent the occurrence of asphyxia, but also gain time for the preparation of surgical treatment. Timing of surgery and choice of anesthesia: Before surgery, patients should be examined by chest X-ray and fiberoptic bronchoscopy to clarify the site of bleeding, as well as to have a comprehensive evaluation of the patient’s general health condition and heart and lung function. The timing of surgery should be chosen in the interval of hemoptysis, when there are few surgical complications and a high success rate. According to the literature, the mortality rate of surgery during active hemoptysis can be as high as 37%, with the majority of patients dying as a direct result of blood aspiration during surgery. In contrast, the mortality rate during surgery in the interval between hemoptysis is only 8%. The choice of intravenous composite anesthesia with double-lumen intubation through the oral trachea is recommended to effectively prevent asphyxia caused by backflow of bloody secretions from the operated side to the healthy lung.