The patient was a 62-year-old man who presented with a nodule in the right upper lobe on X-ray during a medical examination. He had no significant medical history or medication, and blood chemistry findings were normal, including tumor markers and coagulation tests. Chest computed tomography (CT) showed a nodule with a maximum diameter of 20 mm in the right S1 region without enlargement of the lymph nodes (Fig. 1A). Contrast-enhanced magnetic resonance imaging of the head showed no brain metastasis. TBB was performed, and small-cell carcinoma was diagnosed. A small amount of hemoptysis was observed after TBB, but the symptoms disappeared the next day, and the patient was discharged from the hospital upon unremarkable findings on X-ray. Since the patient had small-cell lung cancer, positron emission tomography (PET)–CT was scheduled to assess for distant metastasis. On the eighth day after TBB, the patient was admitted to the hospital as an emergency due to 200–300 mL of hemoptysis. Contrast-enhanced CT of the chest showed scattered shadows around the right upper lobe nodule suggestive of hemorrhage (Fig. 1B). Since hemoptysis was reduced after admission, we continued conservative treatment with hemostatic agents and bronchial artery embolization was not performed. On the 12th day after TBB, SpO2 decreased to 92%, and chest CT showed occlusion of the upper lobe bronchus and the right middle bronchial trunk with hematoma, resulting in complete atelectasis of the right middle and lower lobes (Fig. 2). Emergency thoracotomy of the right upper lobe lobectomy (RUL) and lymph node dissection 2a-2 (ND2a-2) was performed. The operation was performed with differential lung ventilation through a double-lumen tube. The hematoma was occluding the right main bronchus and more centrally located than on the preoperative CT image. The hematoma in the airway was too viscous to be aspirated with suction pressure from the intubation tube. All lobes of the right lung were inflated, and achieving deflation was complicated by the obstruction of the right main bronchus. The pulmonary artery was identified from the interlobar space, and the ascending pulmonary artery was ligated. The minor fissure was dissected first, followed by the superior pulmonary vein and truncus pulmonary artery in this order. The right upper lobe was removed by dissecting the right upper bronchus with a scalpel, and the hematoma was carefully pulled out from the dissected end of the bronchus with forceps (Fig. 3). A suction tube was inserted into the middle and lower lobe bronchus to aspirate the remaining hematoma. The upper lobe bronchus was closed with six stitches using the Sweet method with 4–0 Prolene sutures. The pathological diagnosis was a large-cell neuroendocrine carcinoma with a maximum diameter of 20 mm and pT1bN0M0 Stage I A2. Chest CT on postoperative day 7 showed no atelectasis and good lung expansion. The patient was discharged uneventfully on postoperative day 10.