DISCUSSION: PAVM can be congenital or acquired, with the former being more common. Majority of the congenital PAVM's are associated with hereditary hemorrhagic telangiectasia (HHT)1. PAVM may be asymptomatic or present with a classic triad of dyspnea, cyanosis and clubbing. Hemoptysis can occur from intrabronchial rupture of PAVM or endobronchial telangiectasia. Pregnancy has been associated with an increased rate of PAVM growth and its associated complications2. A high index of suspicion is needed for diagnosis. Diagnosis is made by CTA, calculation of shunt fraction and contrast echocardiography. Treatment options include embolotherapy3 or lung resection if embolization fails.