Hemoptysis is often an alarming presenting symptom. The causes for hemoptysis include infection, cardiovascular disease, cancer, and vasculitis. Massive hemoptysis requires immediate airway protection, early diagnosis and prevention of further hemorrhage. We report a case of pulmonary tuberculosis with hemoptysis as the initial presentation. A high resolution computed tomography of the chest showed multiple nodular infiltrations at the posterior segment of the right upper lobe with a thick-walled cavitary lesion. Hemoptysis stopped spontaneously after conservative treatments and anti-tuberculous therapy. We also reviewed the literature on the causes and treatment of hemoptysis in children.