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Pulmonary Arteriovenous Malformations (PAVM) is abnormal vascular connections between the pulmonary arterial and pulmonary venous circulations having a direct capillary free communication. This creates a Right to Left (R-L) shunt. PAVMs can be either congenital or acquired. A 38 year old female known case of rheumatic heart disease presented with complaint of dyspnea on exertion for 3 days. Her past medical record showed history of balloon mitral valvuloplasty twice for mitral stenosis and hypothyroidism.