A 77-year-old man presented for evaluation of hemoptysis after a 7-month history of cough, progressive dyspnea, and intermittent hemoptysis, which consisted of tablespoon amounts of bright red blood and occurred up to eight times per day. Episodes of intermittent blood-streaked sputum had occurred for 18 months. He denied fevers, rigors, chest pain, palpitations, headaches, nasal symptoms, gastroesophageal reflux, melena, hematochezia, or hematuria. There were no known liver, kidney, or hematologic disorders. The physical examination findings were normal, except for a 4/6 apical pansystolic murmur.