Etoposide was injected locally under sonographic management for the treatment of tubal pregnancy with cardiac activity in the distal region of the tube; the serum beta-hCG level was 14,000 mIU/mL. Two doses of 50 mg each, three days apart, were employed. No side effects appeared either during or after the treatment. Hysterosalpingography performed 1 month 3 weeks after treatment demonstrated the patency of the affected tube. Local etoposide instillation may be an option in the management of unruptured ectopic pregnancies, even in the presence of fetal cardiac activity and high trophoblastic activity.