It is well known that hepatic hemangioma is one of the most commonly treated benign tumors in interventional medicine, and the vast majority of interventional treatments for hepatic hemangioma have excellent results and are very minimally invasive. However, is the “hepatic hemangioma” that is usually detected really a hepatic hemangioma? After all, the diagnosis of hepatic hemangioma is usually diagnosed by imaging rather than pathology. If a patient is diagnosed with hepatic hemangioma after a physical examination and a CT or MR scan + enhancement, and the tumor markers, hepatitis B and C, etc. are normal, can you say to the patient, “This is a hepatic hemangioma, benign, don’t worry, I will do it for you, it is non-invasive and effective. Has it ever occurred to you that there is another possibility? For example, “hepatic hemangiosarcoma”? Our textbooks pass over this disease. We know through the literature that primary hepatic hemangiosarcoma (PHA) is a mesenchymal malignancy of the liver that is clinically rare, difficult to diagnose, and has a rapid progression and poor prognosis. Although it accounts for only 0.4% to 2.0% of primary liver tumors, it is the most common malignant mesenchymal tumor of the liver. The main reason for the difficulty in diagnosis is the lack of specific manifestations of clinical symptoms, laboratory and imaging examinations of hepatic hemangiosarcoma, as well as the small number of cases and the relative lack of experience of physicians. The cause of hepatic hemangiosarcoma is unknown. Chemicals such as vinyl chloride, oyster dioxide and arsenic are known to be closely related to the development of hepatic hemangiosarcoma, but the exact cause of many hepatic hemangiosarcomas remains unclear to date. The main clinical manifestations of hepatic hemangiosarcoma are abdominal pain, malaise, fever, weight loss, abdominal mass and jaundice. Of course, these manifestations are not obvious in the early stage, meaning that there may be no symptoms in the early stage, so it is difficult to distinguish it from benign liver tumors such as hepatic hemangioma, focal nodular hyperplasia of the liver, and liver metastatic tumors. Its laboratory tests are usually negative, most cases have no history of hepatitis and cirrhosis, and tumor markers are usually negative. As for the ancillary tests, hepatic angiosarcoma is also not specific, and its presentation may be similar to hepatocellular carcinoma, hepatic hemangioma and liver metastases, etc. …… It is important to highlight and alert our interventionalists to the fact that some hepatic angiosarcomas are extremely similar to hepatic hemangioma in terms of enhancement, and it is easy to misdiagnose them as hepatic hemangioma, so “Early onset and late return” is not unique to hepatic hemangiosarcoma. Of course, many experts in the literature describe the enhancement pattern of hepatic hemangiosarcoma and hepatic hemangioma as being similar, if not slightly different, but it is difficult to find in normal practice that the vast majority of cases reported in the literature are initially misdiagnosed as hepatic hemangioma, hepatocellular carcinoma or liver metastases, with approximately 40% of patients with pathologically confirmed hepatic hemangiosarcoma having an initial diagnosis of hepatic hemangioma, and some of these presenting as rapidly enlarging “hepatic hemangiomas.” ! According to statistics, the prognosis of hepatic hemangiosarcoma is very poor, if early surgical intervention is possible, the survival time is long, otherwise, death usually occurs quickly due to liver failure or liver rupture and bleeding. Therefore, should we be vigilant if we encounter cases of hepatic hemangiosarcoma rupture and bleeding in our daily work? Is it possible that it is not a hepatic hemangioma but a hepatic hemangiosarcoma? Although the hemostatic solution may be hepatic artery embolization, the prognosis of the disease and the treatment of the family’s condition are completely different! We have encountered a case of ruptured hepatic hemangiosarcoma with bleeding, which was diagnosed as “hepatic hemangiosarcoma” by MRI in a year old patient, and the laboratory tests were negative. “Within two months after the diagnosis of “hepatic hemangioma”, the “hepatic hemangioma” increased rapidly and ruptured twice in a row, and each rupture was stopped by hepatic artery embolization. Finally, the patient died suddenly for unknown reasons, not excluding re-rupture and bleeding. It was highly suspected that it was a hepatic hemangiosarcoma, but unfortunately no pathology was done. Therefore, I think we should be vigilant about hepatic hemangiosarcoma that is usually found, as long as it is not pathologically diagnosed, or at least we should review it regularly, and the interval at the beginning should not be too long. Of course, the incidence of hepatic hemangiosarcoma is still relatively low, and it is usually difficult to encounter, but being that we may work in hospitals for the rest of our lives, can you guarantee that you will not encounter one? So we should not take every hepatic hemangiosarcoma lightly!