Introduction: May-Thurner Syndrome (MTS) is a phenomenon commonly described as acquired stenosis of the left common iliac vein secondary to compression by the right common iliac artery. Right sided MTS is a rare syndrome that can happen due to a left sided inferior vena cava (IVC) and abdominal aorta with a high bifurcation which results in the right common iliac vein being compressed by the left internal iliac artery. It is a rare presentation of this condition which can commonly be missed and management guidelines are less defined compared to classic MTS. Case Report: A 63-year- old female with past medical history significant for hypertension, hyperlipidemia and coronary artery disease presented with five days of worsening right lower extremity (RLE) pain and swelling. Ultrasound of RLE showed extensive deep vein thrombosis (DVT) proximal to distal femoral vein, popliteal, posterior tibial and peroneal vein. She denied history of any reversible etiologies that could have caused clot formation such as prolonged travel, immobilization, usage of hormonal replacements, blood disorders, or malignancies. As the patient continued to have pain with the extent of clot burden the decision was made to perform mechanical thrombectomy. Using ultrasound guidance, a 16F catheter was placed in the right popliteal vein. The venogram revealed an extensive clot burden in the right femoral and external iliac veins, with an incidental finding of 80% stenosis in the right external iliac vein. Mechanical thrombectomy was performed, followed by intravascular ultrasound (IVUS) to assess vessel sizing and evaluate the compression. A 16mm x 60mm Wallstent was placed and post-dilated with a 14mm x 40mm XXL balloon. IVUS was performed to confirm optimal stent placement Discussion: The diagnosis of MTS requires a higher level of suspicion based on diagnostic testing. MTS should be suspected with unilateral lower extremity swelling, unprovoked DVT. Magnetic resonance venography (MRV) and computed tomography venography (CTV) are important to evaluate the central venous system for any stenosis or external compression. However, Venography with IVUS is the gold standard for visualizing the compression of iliac veins and establishing the diagnosis of MTS. Treatment of MTS is dependent on severity of symptoms, presentation and whether the patient has developed DVT. For asymptomatic and patients with mild symptoms conservative management with compression stocking can be followed. However, for moderate to severe symptoms endovascular treatment with stenting is recommended.