What is already known about this topic - Years ago, the clinical and ultrasound characteristics of rare fallopian tube carcinomas were summarized on the basis of a limited sample size. Recent evolutions in pathological diagnostic criteria have substantially increased reported morbidity; however, clinical and ultrasound feature descriptions have remained outdated What this study adds - We retrospectively reviewed the clinical and ultrasound features of a large sample of patients with primary fallopian tube carcinoma. We identified several new clinical and ultrasound features that may be useful for the early clinical diagnosis of primary fallopian tube carcinoma. How this study might affect research, practice or policy - The treatment strategy for primary fallopian tube carcinoma parallels that for ovarian malignancy; however, primary fallopian tube carcinoma lesions are characterized by early dissemination. This study elucidated several unique features of primary fallopian tube carcinoma, which enable early diagnosis and improve patient prognosis. This study aimed to describe the sonographic and clinical characteristics of primary tubal carcinoma, a rare gynecological malignancy. This was a retrospective, single-center study that included 280 patients with postoperative histologically diagnosed fallopian tube carcinoma. All patients underwent preoperative ultrasound and surgery at Obstetrics and Gynecology Hospital of Fudan University from 2020-2024. Clinical data and ultrasound data were collected. The most common complaint was abdominal pain/bloating (35.71%), whereas 42.14% were asymptomatic. High-grade serous carcinoma was the predominant histological type (95.36%). Unilateral masses were more common (47.14%). Oval masses were the most prevalent ultrasonic appearance (58.15%). Endometrial fluid was observed in 28.57% cases. In 67.15% of cases, ultrasound accurately described the dominant mass in accordance with the intraoperative observations. The ovarian-dominant masses had significantly greater CA125 levels and larger diameters than the tubal-dominant masses did. Abdominal pain/distension and the presence of endometrial fluid should receive increased attention in the diagnosis of tubal cancer. A characteristic pattern of "large metastases and small primary lesions" was found via tubal cancer sonography. Oval lesions were observed more frequently than sausage-shaped lesions in fallopian tube cancer, with the masses predominantly being solid or predominantly solid.