<p>Spontaneous hemoperitoneum (SH) is defined as the presence of blood within the peritoneal cavity from a non-traumatic origin. The absence of clinical suspicion and its low frequency render it a challenging diagnosis in the emergency setting. As it is a potentially life-threatening condition, radiologists play a fundamental role in the identification and location of the source of bleed, both essential to be able to deliver the best care possible for the patient. This review article aims to facilitate a practical approach to SH: We will begin by reviewing key imaging modalities of significant value for the detection and characterization of SH. Relevant anatomy and important CT signs to know will be mentioned. We will summarize the potential causes of SH in order of frequency, with a brief mention of differential diagnoses to consider. Finally, we will illustrate this review with a collection of cases from our hospital to showcase relevant diagnoses to consider when facing a patient with SH, focusing on key imaging elements that should not be overlooked.</p> Graphical Abstract <p></p>