A case of renal cell carcinoma causing spontaneous rupture is reported. A 45-year-old male patient complaining of right flank pain without any trauma was referred to our hospital. Computerized tomography (CT) and angiography demonstrated extracapsular hemorrhage with renal cell carcinoma and right radical nephrectomy was performed. Hemorrhage was recognized in the peritoneal and retroperitoneal space. Pathological diagnosis was renal cell carcinoma. Thirteen cases of spontaneous rupture of renal cell carcinoma in the Japanese literature are reviewed. CT proved to be the most valuable imaging for differentiation. There was intraperitoneal bleeding in 3 of the 13 cases.