Pulmonary arteriovenous malformations (PAVM's) are rare pulmonary vascular anomalies. PAVM's consist of abnormal communications between pulmonary arteries and pulmonary veins, causing right-to-left shunting, and thus, frequently with hypoxemia and dyspnea on exertion, although may remain asymptomatic and frequently undiagnosed, unless complications occur. This report presents a PAVM rupturing to the left pleura, a very uncommon clinical problem, but it is an important differential diagnosis of common pulmonary problems such as hemothorax, hypoxemia, and pulmonary nodules. We report a case of a 25 year old female with symptoms of chronic cyanosis and sudden onset of dyspnea. On radiologic evaluations, she was found to have multiple bilateral pulmonary arteriovenous malformations (PAVMs) with multiple blood supply coming from the pulmonary artery. A large PAVM from the left lung that ruptured to the left pleura was documented. An open surgical left lower lobectomy was successfully performed after a failed transcatheter embolization. This was complicated by postoperative empyma a month after hospital discharge which was managed with antibiotics, thoracostomy, open thoracotomy and drainage of empyma and decortication. Patient remained asymptomatic six months after the surgery. Diagnostics and treatement options for multiple PAVMs and management of postoperative empyma are discussed in this paper.