Pulmonary capillary hemangiomatosis (PCH) is a rare cause of pulmonary hypertension characterized by uncontrolled capillary proliferation in the pulmonary interstitium and alveolar walls. Lung transplantation remains the only definitive treatment. To date, there have been no reported cases of recurrent PCH after lung transplantation. We present a case that describes important radiologic and clinical features of PCH and raises questions about its pathogenesis.