In Brief Sarcoidosis is a multisystem disease of unknown cause that primarily affects the lungs. Although the lung is involved in over 90% of the cases, hemoptysis as a presenting feature is rare. The MEDLINE database of the National Institutes of Health was used to search the available literature. Patients with concomitant mycetomas or malignancies were excluded. We conclude the following: (1) When hemoptysis is the initial manifestation of sarcoid, endobronchial involvement is usually present. (2) Hemoptysis is rarely massive or life-threatening, except when associated with mycetomas in radiographic stage IV. (3) Most of the cases reviewed were in radiographic stages I or II. (4) The treatment favored by most is corticosteroids, which usually results in total resolution. We report a case of a 47-year-old woman presenting with hemoptysis as her initial symptom of sarcoidosis. Although the lung is involved in over 90% of cases, hemoptysis as a presenting symptom is rare. To determine the incidence, radiographic staging, and the pathologic findings of sarcoidosis presenting with hemoptysis, an extensive literature review was undertaken.