Spontaneous hemoperitoneum is an uncommon cause of acute abdominal pain. When it occurs, it may be catastrophic. There are a myriad of causes for spontaneous hemoperitoneum and an underlying cause should always be looked for if the patient survives the initial event. This article describes the imaging findings of spontaneous hemoperitoneum and discusses the relative merits of multiple imaging modalities used for the diagnosis of the hemoperitoneum and an underlying cause. In addition, we outline the etiology of spontaneous hemoperitoneum, which includes hepatic, splenic, gynecologic, and vascular causes, and bleeding disorders.