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Thank you for the great question!
Although we occasionally see duplicated IVC's, from our experience they tend to be slightly bigger than the vein in the picture and are quite apparent when scanning in a supine midline lower abdominal plane...although they can divide at the level discussed.
The consensus from the SIG members was that the vein in question is most likely the Ascending Lumbar Communicant Vein. This vein also can join the renal vein similar to what you are describing and has an almost vertical orientation.
Clinicians are happy when these are found, because if the patient requires spine surgery that has an anterior surgical approach where the major vessels are lifted, this is a vein that is easily ruptured.
As there was a mention of a partial Nutcracker compression, we wanted to address this for you as well. A true Nutcracker will cause renal hypertension with symptoms of haematuria and left flank pain needed for diagnosis. Without these symptoms it is likely that the LRV is simply being underfilled, this can occur when the main draining pathway is via an Ascending Lumbar Communicate Vein, an incompetent left ovarian vein, or a circum-aortic left renal vein. This underfilling is the most common cause for a false positive Nutcracker compression. I've attached recently published papers on this for you to look through.
One technique we are employing is assessing the patient in an LPO position and reassessing the anatomy.
Thanks again for such a great question on a complex topic.
Kind regards,
Vascular SIG
Ultrasound characteristics and risk factors of female patients with pelvic varicose veins and concomitant chronic pelvic pain - Journal of Vascular Surgery: Venous and Lymphatic Disorders
Nutcracker syndrome (a Delphi consensus) - Journal of Vascular Surgery: Venous and Lymphatic Disorders