Heterotopic pregnancy is very rare condition, it is estimated to occur in 1 in 30.000 natural pregnancies. Sometimes, the condition is a dilemma with respect to the diagnosis and the management. Biochemical tests (such as serial ß-hCG level, serum progesterone measurements) and imaging studies may not be diagnostic in all time. Definitive diagnosis may only be reached via laparoscopy or laparotomy. A 33-year-old pregnant woman (gravida 1, para 0) was referred to our hospital with the complaint of severe abdominal pain and further evaluation of left adnexal complex cystic solid mass. Transvaginal ultrasonography and magnetic resonance imaging studies revealed 12 weeks’ live intrauterine pregnancy and an additional left adnexal echogenic complex cystic and solid mass (10 cm x 6 cm in diameter) with high amount of free fluid in the peritoneal cavity. Emergency laparotomy confirmed the diagnosis of ruptured left tubal ectopic pregnancy with live intrauterine fetus. The clinicians should keep in mind the diagnosis of heterotopic pregnancy even in negative findings on clinical symptoms, laboratory evaluation, transvaginal ultrasonography and magnetic resonance imaging studies.