Objective To study the relationship of hepatitis B virus (HBV) to spontaneous rupture of hepatocellular carcinoma (HCC-SR) and its mechanism. Method The related literatures about theory of HCC-SR were consulted and reviewed. Results The injury of small arteries was usually followed in patients with HCC-SR, which was related to vascular autoimmune injury caused by the HBV infection. The small arteries in which immune complex deposited were readily injured, as a result HCC-SR happened while vascular load increased. Conclusion The HBV infection resulted in vascular autoimmune injury maybe a important factor in the pathogenesis of HCC-SR.