Spontaneous rupture of primary angiosarcoma of the spleen is an uncommon cause of acute abdominal pain and hemoperitoneum. Clinical findings and presentation are nonspecific and variable. CT is frequently used as a first-line imaging modality in the evaluation of acute abdominal pain; however, findings are not specific for angiosarcoma. We report a case of primary splenic angiosarcoma with spontaneous rupture, hemoperitoneum, and hepatic metastases in a patient presenting to the emergency department with acute left upper quadrant pain and fever.