A young man presented with a short febrile illness associated with signs of cough, sputum and haemoptysis (>200 ml/24 h) to his local hospital. The chest radiograph revealed a small cavity in the upper zone with patchy consolidation. He was kept in isolation awaiting a bronchoscopy for tuberculosis (TB). He developed sudden, severe haemoptysis and died as a result of exsanguination within a short space of time and could not be resuscitated. Post-mortem examination revealed dehiscence of the aortic wall from necrotising tubercular lymphadenitis. This illustrates the importance of recognising that patients with TB and haemoptysis have a high risk of massive haemoptysis and need to be closely monitored as early arterial embolisation and cardiothoracic surgical intervention back-up may be necessary to save lives.