An Additional Left Renal Vein Draining via a Duplicated Left Ovarian Vein Associated with Pelvic Venous Congestion: A Case Report and Literature Review

An exceptionally rare venous anatomical variation was identified in a 101-year-old woman undergoing contrast-enhanced abdominal computed tomography for the evaluation of abdominal pain. Imaging demonstrated duplication of the left renal vein, with an inferior additional renal vein draining into a partially duplicated left ovarian vein (LOV). The ovarian vein subsequently drained into the superior main left renal vein, creating a reno-ovarian-renal venous pathway. The inferior renal vein drained the mid and lower portions of the kidney, serving as a major renal venous outflow pathway. The LOV was markedly dilated, with imaging features of left-sided pelvic venous congestion. While drainage of an accessory renal vein into the ovarian vein has been reported previously, involvement of a large-caliber, functionally significant renal vein has not been described to our knowledge. This configuration establishes a direct anatomical substrate for reno-ovarian reflux and may represent an underrecognized etiologic factor in patients evaluated for pelvic venous congestion. Awareness of such variants is essential for accurate radiologic interpretation and for preventing potential complications during gonadal vein embolization and retroperitoneal surgical or endovascular procedures.