Pyogenic granuloma gravidarum (PGG) is a benign fibrovascular lesion arising during pregnancy. This report concerns a woman in her third trimester of pregnancy with recurrent left epistaxis and a swelling in her left nostril. She was diagnosed with PGG via magnetic resonance imaging (MRI) and nasoendoscopy. The lesion was managed conservatively and the neonate was delivered without complication at 37 weeks of gestation. Evidence shows that MRI is superior to computerised tomography (CT) in the assessment of soft-tissue masses, but there is a paucity of MRI PGG imaging in the literature. This report shows that MRI, together with the clinical context, is adequate to make a diagnosis of PGG. This was a rare case of a nasal lesion that was allowed to involute conservatively, hence avoiding the potential complications of surgery. This appears to be the first published report to include a follow-up to a successful second pregnancy and delivery without the recurrence of PGG.