Liver hemangiomas have an estimated prevalence of 0.4 to 20%. Being devoid of malignant potential, they are usually discovered between that fourth and fifth decade of life during an abdominal imaging workup.¹

Hemangiomas have been classified according to pathology into three varieties: capillary hemangioma, cavernous hemangioma, and mixed type hemangioma.²

Most liver hemangiomas in adults are cavernous hemangiomas³. Their imaging features are well known, as their pathological examination (Fig.1) that reveals a characteristic focal tender mass formed by multiple vascular channels limited by a single layer of endothelial cells within a thin fibrous stroma. In general, the blood circulation within these tumor vessels is slow.

Morphologically, it is a well-defined lesion possessing round or lobulated margins. Although it may occur anywhere in the liver parenchyma, it is more commonly seen at peripheral and sub-capsular locations, mostly in the posterior segments of the right lobe^{6, 7,9.}

Their size usually remains stable and can vary from a few millimeters to more than 20 cm, a feature that has been used for its classification into small (<15 mm), medium (15–50 mm) and large hemangiomas (>50 mm)⁷.

Large hemangiomas may be associated with complications in 4.5 to 19.7% of cases, consisting of bleeding, compressive effect on adjacent structures and torsion if pedunculated.

Liver hemangiomas have specific imaging features, allowing its confident diagnose with cross-sectional imaging techniques. There is, however, a wide range of findings that fall out of their typical description, which are, essentially, due to modifications of the tumor structure or flow dynamics. Current state of-the-art imaging techniques are more prone to demonstrating these findings, thus, increasing their diagnostic confidence level.