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Introduction Chronic ectopic pregnancy, a rare diagnostic challenge, can mimic ovarian masses. This case highlights the importance of vigilance in atypical adnexal masses to prevent delayed diagnosis and ensure optimal outcomes. Aims and objectives The aim is to present a rare case of chronic ectopic pregnancy masquerading as an ovarian mass, emphasizing diagnostic challenges. Objectives include reviewing clinical features, imaging findings, differential diagnosis, management strategies, and highlighting the importance of early identification for optimal outcomes. Materials and methods In this case report, we retrospectively analyzed the clinical presentation, diagnostic workup, and management of a patient diagnosed with chronic ectopic pregnancy masquerading as an ovarian mass. Data was collected from patient history, physical examination, imaging studies (ultrasound, MRI), and laboratory results (?-hCG levels). The patient underwent surgical intervention, and histopathological examination confirmed the diagnosis. A comprehensive literature review was conducted to compare this case with previously reported instances of chronic ectopic pregnancies and their diagnostic challenges. Results The 34-year-old female presented with abdominal pain and a palpable adnexal mass. Laboratory tests, including ?-hCG, were negative for pregnancy and chronic ectopic pregnancy. Laparotomy revealed hemoperitoneum with no evidence of rupture. Intraoperative findings confirmed a chronic tubal abortion, with trophoblastic tissue identified in the fallopian tube, consistent with a resorbed ectopic pregnancy. Histopathological examination confirmed the diagnosis of chronic ectopic pregnancy. The patient had an uneventful postoperative recovery. Conclusions Chronic ectopic pregnancy, particularly tubal abortion, poses diagnostic challenges due to non-specific symptoms and negative ?-hCG results. This case highlights the importance of a high index of suspicion, as imaging can mimic ovarian masses. Surgical intervention with histopathological confirmation is essential for accurate diagnosis and management. Early recognition and a comprehensive diagnostic approach are crucial to avoid complications, ensure appropriate treatment, and improve patient outcomes, including fertility preservatio