Abstract
Ruptured ovarian ectopic pregnancy (ROEP) is a rare and life-threatening condition that can increase maternal morbidity and mortality. This case report describes a patient with an atypical presentation that illustrates the diagnostic difficulty of ROEP. Due to overlapping clinical features, it was initially misdiagnosed as an ovarian malignancy. We review relevant clinical symptoms, βHCG trends, and imaging findings that should be evaluated together when considering differential diagnoses. Although most ROEPs are ultimately diagnosed intraoperatively and by histopathology, this case report highlights key diagnostic decision points in the setting of ambiguous clinical and radiologic findings.