Diagnostic Pitfall: Intrauterine Pseudogestational Sac Mimicking an Anembryonic Pregnancy in Tubal Ectopic Pregnancy A Case Report

Purpose: Ectopic pregnancy is a potentially life-threatening condition, and its diagnosis may be complicated when an intrauterine pseudogestational sac mimics a nonviable intrauterine pregnancy. This diagnostic pitfall can lead to mismanagement and delay in appropriate treatment. Case Presentation: A case of a 33-year-old woman (G4P2A1) at 9– 10 weeks of gestation presenting with vaginal bleeding. Ultrasonography revealed an intrauterine sac suggestive of blighted ovum and a concomitant adnexal mass suspicious for ectopic pregnancy. Curettage was performed, yielding tissue that on histopathology showed endometrial hyperplasia without chorionic villi, consistent with a pseudogestational sac. Subsequent exploratory laparotomy revealed a right tubal abortion, and right salpingectomy was performed. Histopathological examination confirmed chorionic villi within hemorrhagic tissue. The postoperative course was uneventful, and the patient was discharged in good condition. Conclusion: This case highlights the diagnostic challenge of differentiating a pseudogestational sac from a nonviable intrauterine pregnancy in ectopic pregnancy. A sac-like intrauterine structure alone is insufficient to confirm intrauterine pregnancy, and accurate diagnosis requires integration of serial β-hCG assessment, repeat transvaginal ultrasonography, and histopathological evaluation. Awareness of this diagnostic pitfall is essential to avoid unnecessary uterine intervention and ensure timely, appropriate management.