Right portal branch to ovarian vein anastomosis: An unusual portosystemic shunt secondary to pelvic venous congestion

Spontaneous portosystemic shunts in noncirrhotic patients are rare vascular anomalies and may present a diagnostic challenge. We report a rare right-sided spontaneous porto-ovarian venous communication in a 35-year-old woman presenting with symptoms of pelvic venous congestion. Contrast-enhanced CT performed during the portal venous phase demonstrated a segmental branch of the right portal vein anastomosing with a markedly dilated and tortuous right ovarian vein, associated with parametrial and pelvic varices. The right ovarian vein was traced inferiorly and confirmed to drain into the inferior vena cava. The main portal vein and intrahepatic branches were patent, with normal hepatic enhancement and no imaging evidence of cirrhosis, portal thrombosis, or portal hypertension. To our knowledge, only 1 similar case involving the left ovarian vein has been reported in indexed literature. Recognition of this rare porto-ovarian communication is essential to avoid diagnostic pitfalls and to guide appropriate management strategies in patients presenting with pelvic venous congestion.