IntroductionHemoptysis can be a highly alarming presentation in the emergency department (ED). Even seemingly minor cases may represent potentially lethal underlying pathology. It requires thorough evaluation and careful consideration of a broad differential diagnosis.Case PresentationA 44-year-old man presented to the ED with a concern of hemoptysis in the setting of recent fever and myalgias.DiscussionThis case takes the reader through how to approach the differential diagnosis and diagnostic work-up of hemoptysis in the ED setting and then reveals the surprising final diagnosis.