Echogenic intraperitoneal fluid in any quantity noted on sonography is thought to indicate a very high likelihood of ectopic pregnancy (EP) in patients at risk. We retrospectively reviewed 12 consecutive symptomatic patients with a positive pregnancy test in whom sonography revealed echogenic fluid as an isolated finding without evidence of intrauterine pregnancy and in whom follow-up was available. Final diagnoses were EP in seven patients (58%) and spontaneous abortion in five (42%). EP was diagnosed in all four patients with a large amount of echogenic fluid, but in only three (38%) of eight patients with a small-to-moderate amount of echogenic fluid. We conclude that a small-to-moderate amount of echogenic fluid noted as an isolated finding may not be highly predictive of EP.