CASE PRESENTATION: A 51 year-old woman never smoker with Alagille syndrome (branch pulmonary artery stenoses, patent ductus arteriosus, ventricular septal defect, severe pulmonary hypertension, renal dysplasia) presented with episodic massive hemoptysis. Brisk bleeding was encountered at flexible bronchoscopy. A 5 mm nodular lesion ejecting bright red blood was identified in the left lower lobe (panel A). After hemostasis, a pulsatile superficial vessel running along a secondary carina with protruding white-capped tortuous loop or aneurysmal dilation was clearly visible (panels B-D). The lesion was obliterated with Nd:YAP laser (panels E, F). The patient discharged the next day with no further hemoptysis at 4 months follow-up.