Transplant recipients are at an increased risk of developing malignancies, which are an important cause of mortality. Many risk factors are linked to the increased incidence of malignancies after transplantation including type, intensity, and duration of immunosuppression, viral infections and sun exposure. The occurrence of angiosarcoma in the Arterio-venous Fistula (AVF) site in a post-transplant patient is a rare phenomenon. It is an aggressive tumor with a high rate of local recurrence and systemic metastasis. There are no specific guidelines for the treatment. They are treated with a multimodality approach of surgery, chemotherapy and radiotherapy. We present a case of Epithelioid Angiosarcoma developed at AVF site in a patient with dual Pancreas-Renal Transplant who also had lung metastasis at the time of histologic diagnosis. The presenting symptoms were very non-specific and careful evaluation with histopathological assessment and imaging findings helped in early diagnosis and management.