Massive hemoptysis is not an uncommon surgical problem. A systematic yet flexible and multidisciplinary approach leads to optimal outcomes. The initial focus should be on stabilizing patients and securing the airway, which should be followed by methods to stop the bleeding, preferably nonsurgical methods. Consideration for definitive therapy should ensue, including surgical therapy for appropriate patients. This review outlines the management of patients with massive hemoptysis from benign and malignant causes.