A heterotopic pregnancy is a rare but potentially life threatening condition characterized by the simultaneous presence of an intrauterine and extrauterine pregnancy. Although uncommon in naturally conceived pregnancies, delayed diagnosis can lead to rupture or hemorrhage, placing the intrauterine pregnancy (IUP) at significant risk. This case report involves a patient in her first trimester, approximately 8 weeks 5 days of gestation, who presented with pelvic pain. Transvaginal sonography revealed an IUP and an ectopic pregnancy in the right adnexa, consistent with heterotopic pregnancy. Two corpus luteum cysts were identified on the contralateral ovary, a rare finding that further emphasizes the importance of bilateral adnexal assessment during early pregnancy evaluation. A laparoscopic right salpingectomy was performed, and the IUP remained viable after surgical intervention. This case study underscores the essential role of the sonographic evaluation in early pregnancy and emphasizes the importance of assessing the adnexa, even when an IUP has been confirmed.
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