Transplant renal vein stenosis (TRVS) is a rare vascular complication of renal transplant that can masquerade findings of rejection and infection. We report a case who presented 2 years 9 months post-transplant with localized non-tender heaviness and fullness at the graft site with renal dysfunction. Initial ultrasonogram (USG) was suggestive of graft pyelonephritis with perinephric collection, though, there were no clinical features of infection and cultures came as sterile. Doppler revealed findings of TRVS, which was confirmed with a CT angiogram. Graft vein angioplasty restored the hemodynamics, but the patient again presented after 4 months with incidentally detected graft dysfunction. USG Doppler showed graft vein stenosis at the same site, which was managed with an elective renal vein angioplasty with stent placement.