Chronic ectopic pregnancies (CEPs) represent a rare and often under-recognized form of ectopic gestation, typically evolving insidiously over weeks. Unlike acute presentations, CEPs frequently lack overt clinical signs, leading to delays in diagnosis. Their imaging features, particularly on transvaginal ultrasound, often mimic pelvic tumors or complex adnexal masses, posing a diagnostic dilemma. Early recognition of these atypical presentations is essential to prevent complications and ensure appropriate surgical intervention. This study aims to improve awareness of this rare clinical entity among gynecologists and radiologists.