Arterioportal shunt is an important hemodynamic alteration in the liver, may cause severe portal hypertension, consequently ascites, esophageal varix, or accelerating intra- and/or extravascular metastasis of carcinoma cells. Understanding of these findings will contribute to the diagnosis and prognosis of the disease and improve therapeutic efficacy for the patients. We report a case of hepatocellular carcinoma with arterioportal shunt, which was difficult to treatment.