An 18-year-old Japanese man admitted to our hospital for an evaluation of bilateral multiple small nodules revealed by a chest X-ray during a medical examination. He experienced hemosputum, and treatment with oral antibiotics was ineffective symptomatically and radiographically. His chest computed tomography (CT) demonstrated randomly distributed bilateral multiple small pulmonary nodules. Pathological findings of the specimens obtained by transbronchial lung biopsy (TBLB) from left S5 revealed a proliferation of epithelium-like tumor cells with mild nuclear atypia, vacuolated cytoplasm, and intracytoplasmic red blood cells in them. The cells were also positive for CD31, CD34, and factor VIII. From these pathological features, a diagnosis of pulmonary epithelioid hemangioendothelioma (PEH) was made. He had been treated only with oral hemostatic agents that made his symptoms of hemosputa disappear, and his chest radiographic findings had shown only a slight increase of bilateral multiple nodules, small in size, three years after the diagnosis. The cases with PEH diagnosed only by TBLB are rare, and we speculate that the size and location of pulmonary nodules in relation to the accessibility of transbronchial biopsy forceps via fiberoptic bronchoscopy may be important for the diagnosis of PEH by TBLB.