There are 2 main and different forms of hepatic hemangiomas--those of early childhood and those of later adult life. The former, called infantile hepatic hemangioendothelioma, may be life-threatening due to arteriovenous shunting in extensive lesions resulting in cardiac failure. Although they may resolve spontaneously, if cardiac failure develops, they must be treated aggressively by arterial ligation or embolization. The adult form rarely gives rise to symptoms and should be left alone. Spontaneous rupture is extremely rare but may follow needle biopsy and it is in this group of patients that the occasional death has been reported. Biopsy should, therefore, be avoided. Symptomatic lesions should be resected in a specialized center where the morbidity and mortality of liver resection is acceptably very low.