A case of hemorrhagic cardiac tamponade after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) leading to death is presented. The complication occurred during a procedure performed under general anesthesia with an expandable needle system for a 2-cm HCC sited in the second segment of the liver close to the diaphragm. Thermal damage to the organs surrounding the liver are major complications of liver tumor RFA. For lesions that are adjacent to the cardiac cavities, a discussion of better therapeutic options remains necessary and has to take into account the effectiveness and complication rate of each technique.