Diffuse cavernous hemangioma of the rectosigmoid colon (DCHR) is an uncommon disease that affects mainly young adults. As the main symptom is non-specific chronic rectal bleeding, the clinical diagnosis is difficult and often delayed. In this essay, we illustrate the imaging features of DCHR, including plain radiograph, barium enema, CT and MR study, and echoendoscopy. Pitfalls in diagnosis and the role of imaging study in the diagnosis, in the preoperative staging, and in the follow-up of the patients are defined.