Renal lymphangiectasia/lymphangioma (RLM) is a rare condition characterized by dilatation of perirenal, parapelvic or intrarenal lymphatics, and hypothesized to result from malformation of lymphatic tissues. Before 2002, invasive biopsy and aspiration were used to confirm diagnosis. The authors propose that non-invasive radiological imaging may be sufficient to diagnose the condition and exclude differentials. We report a case of a 20 year-old male with longstanding flank pain, diagnosed with bilateral renal lymphangietasia on CT IVP, with a review of existing literature. A PubMed search using the search terms “renal lymphangiectasia”, “renal lymphangioma” “perirenal collections”, “imaging”, "diagnosis" was performed to review relevant articles dating from 2015 to present. In a 2011-2016 single-center study by Vaidehi K. Pandya et al., CT IVP scans of 8 patients incidentally diagnosed with RLM were studied.. Arterial and venous phase showed non-enhancing collection with average HU density 0-10HU, delayed phase showed normal contrast excretion. A 2020 case report by Simone Guadagni et al. described the first ever case of RLM diagnosed on contrast-enhanced US in a 27 year-old female. In a 2022 case series by Yanyu Li et al., out of 4 patients diagnosed with RLM, 1 underwent contrast-enhanced US only, 2 underwent contrast-enhanced US and subsequently CT IVP, and the last patient was screened with simple US. Neither of them underwent aspiration. Renal lymphangiectasis is a lesser known condition and can be commonly misdiagnosed. There has been a paradigm shift towards relying on radiological imaging solely for diagnosis, omitting the need for invasive biopsy/aspiration. Nevertheless, certain limitations hold – patients with poor renal function are not suitable for contrasted scans, US is susceptible to intestinal gas interference and MRI can have long scan time subjecting images to motion artifacts. It is key to individualize workup on a case-by-case basis to ensure timely diagnosis and intervention.