Bilateral lower limb deep vein thrombosis as a sole presenting symptom is a rare but documented manifestation of Hon Hodgkin lymphoma. We present the case of a 51 year old otherwise healthy and active male with no recent trauma or travel history who presented to the hospital with bilateral lower limb swelling of 12 days duration. Lower extremity Doppler revealed extensive bilateral deep vein thrombosis extending upto the level of the common iliac veins. CT contrast studies of abdomen, pelvis and chest revealed mediastinal and chest lymphadenopathy with occlusion of Inferior Vena Cava. Thrombophilia and collagen vascular disease workup was negative. In view of enlarged supraclavicular lymph nodes as confirmed by ultrasound neck, excision biopsy of left supraclavicular lymph node was performed which showed a high grade non-Hodgkin large cell lymphoma. Patient was started on anticoagulation and referred to Oncology services for further management. Clinicians should exercise due care and diligence and appropriately investigate otherwise healthy active adults presenting with unprovoked bilateral DVT and no other apparent cause as it could be the harbinger of asymptomatic or occult malignancy.