Varicosities of the valleculae: an unusual cause of hemoptysis?

Hemoptysis is a common respiratory symptom causing a great deal of anxiety. The cause is often apparent following a clinical history, upper-airway examination, bronchoscopy, and CT scanning of the thorax. We present a case of massive hemoptysis, the etiology of which was not readily apparent despite this conventional approach. Vallecular hemorrhage has been previously reported but is usually minor unless associated with surgical trauma, and can be readily missed if not aware of the possibility. We speculate about the etiology and mechanism for recurrent hemorrhage.