Case presentation. A patient in his late thirties with HIV, tuberculosis (4-drug treatment in 2009), and LUL cavitary lesion with aspergilloma presenting with life-threatening hemoptysis. a Single image from axial computed tomography shows aspergilloma (arrowhead), which was the likely etiology of this patient’s hemoptysis. b Flush thoracic aortogram demonstrates hypertrophied bronchial arteries (curved arrow) and superior intercostal arteries (straight arrow) supplying the aspergilloma. c Representative image of selective angiogram of the larger of the 2 left bronchial arteries shows hypertrophied bronchial artery (curved arrow). d Angiogram of the bronchial artery (curved arrow) post-bronchial artery embolization with 300–500 μm particles (trisacryl gelatin microspheres) via selective microcatheter demonstrates lack of blood flow to the area of the aspergilloma. e Angiogram of the left subclavian artery to evaluate for non-bronchial systemic collaterals demonstrates abnormal neovascularity filling from the left internal mammary artery (straight arrow) and lateral thoracic artery (curved arrow) on the left side. f Representative image of selective angiogram of the lateral thoracic branch on the left. g Angiogram shows inflammatory neovascular blush (arrowhead) with shunting to the main pulmonary artery (straight arrow). h Post-procedural angiogram with 500–700 and 700–900 μm particles demonstrates successful embolization of the lateral thoracic branch on the left.