RATIONALE: Bronchial Dieulafoy disease (BDD) is caused by vascular malformations in the bronchial wall, which may rupture and bleed spontaneously or due to external factors. Bronchial artery embolization (BAE) is the treatment of choice. PATIENTS CONCERNS: The patient in this case had a 15-year history of recurrent hemoptysis, which persisted despite aggressive medical treatment. Due to a stent in the iliac artery, conventional transfemoral BAE was not feasible. DIAGNOSES: Fiberoptic bronchoscopy revealed exposed mucosal vessels with vascular malformations in the left upper lobe. Bronchial artery angiography further demonstrated arterial malformation, tortuosity, and hypertrophy at the lesion site, consistent with a diagnosis of BDD. INTERVENTIONS: The patient successfully underwent BAE via a left distal radial artery puncture. OUTCOMES: The patient's lesion was utterly resolved during the 1-year follow-up, with no disease progression. LESSONS: Clinicians should consider BDD in cases of unexplained hemoptysis. BAE is the preferred treatment, and if conventional transfemoral access is not feasible, the radial artery can serve as an alternative approach. This case provides practical support for diversifying interventional techniques in BAE.