Left Renal Vein Pseudo-Fenestration

We describe a rare case of LRV pseudo-fenestration in a 68-year-old female identified on contrast-enhanced multidetector computed tomography. Unlike true fenestration, in which a single vessel splits and reunites, this pseudo-fenestration resulted from the convergence of two distinct hilar venous trunks. Multiplanar and three-dimensional reconstructions demonstrated that the left suprarenal vein drained into the superior limb, whereas the left gonadal vein drained into the inferior limb, reflecting a consistent and anatomically meaningful tributary pattern. This configuration is most plausibly explained by incomplete or asymmetric embryological fusion of the cardinal venous system. Accurate preoperative recognition of this variant is clinically important to reduce the risk of iatrogenic injury during laparoscopic donor nephrectomy, adrenal venous sampling, and other retroperitoneal or endovascular procedures.