Five patients with pulmonary hemorrhage associated with SLE were studied. Chest radiographs showed extensive alveolar opacity immediately after hemoptysis or dyspnea in four patients. In one patient an interstitial pattern seen initially progressed rapidly to an alveolar pattern. Three patients were successfully treated with corticosteroids and are doing well at present. The diagnosis and treatment of pulmonary hemorrhage is vital to patients with SLE. In the appropriate clinical setting chest radiographic findings of acute alveolar disease should suggest pulmonary hemorrhage, and empiric treatment with corticosteroids should be considered.