Spontaneous rupture of pheochromocytoma is very rare and fatal. We report a case of spontaneous rupture of adrenal pheochromocytoma. The 49-year-old male with previously diagnosed right renal mass visited our emergency department because of suddenly occurred right flank pain. Abdominal computerized tomography was performed and we found right renal mass rupture with a hematoma in the retroperitoneal space. His systolic blood pressor was more than 200 mmHg even ongoing internal organ bleeding. We suggested transcatheter arterial embolization for renal and suprarenal arteries. After embolization, he admitted to ICU. Next day, his vital sign was unstable, he was applied ECMO. His laboratory results showed Epinephrine 1052.2 ㎍/day, Norepinephrine 10714.5 ㎍/day, Dopamine 221.5 ㎍/day, Metanephrine 7714 ㎍/day, Normetanephrine 38758 ㎍/day, 17-OHCS (24hr urine) 32 mg/day, 17-Ketosteroid (24hr urine) 30.50 mg/day. Even weaning of ECMO after cardiac function recovery, on hospital day 13, he expired because of multiple organ failure.