Abstract Background The aim of this study was to propose a localization strategy for bleeding sites in hemoptysis patients using their chest computed tomography (CT) findings. Methods Between January 2005 and July 2009, the chest CT findings of 161 hemoptysis patients were retrospectively reviewed. Following chest CT, the lobe with the most prominent ground glass attenuation (GGA) or specific lesions with the potential to cause pulmonary hemorrhage were analysed to develop a localization strategy for bleeding sites. Fibre optic bronchoscopy (FOB) findings of active bleeding were used as the standard reference for the bleeding sites. Results The concordance rate between the most prominent GGA and FOB findings was higher than that between specific lesions and FOB findings (Kappa value [ k ] = 0.751 vs. 0.448, p