Thiazolidinediones are currently indicated for the treatment of Type 2 Diabetes. This class of drugs has been associated with several adverse reactions associated with volume overload. This report describes a case of a 65 year old African-American female with a history of hypertension and obesity, and taking rosiglitazone (Avandia) for her Type 2 Diabetes whose evaluation for chest pain resulted in the incidental finding of pulmonary hypertension noted on echocardiogram. The subsequent evaluation, follow-up and treatment are discussed along with potential pitfalls and implications for clinical care.