We describe a case of spontaneous total necrosis of hepatocellular carcinoma (HCC). Contrast-enhanced CT scanning revealed a hypoattenuating mass during both the hepatic arterial and portal venous phase. During the latter, subtle capsular enhancement was noted. Ultrasonography demonstrated the presence of a hypoechoic mass with a peripheral hyperechoic rim. The patient underwent tumorectomy, and a totally necrotic mass was found. Microscopic examination revealed necrotic tissue with HCC ghost cells, suggesting spontaneous total necrosis of HCC.