Hepatic cavernous hemangioma is the most common benign tumor of the liver and the most frequently encountered problem in hepatic surgery. Its benign course, its different sites, growth patterns and biological characteristics, combined with the complex liver surgery involved, have led to a long-standing lack of consensus among surgeons regarding its treatment. Hepatic cavernous hemangioma is easy to diagnose, but the adverse consequences of misdiagnosis are very serious. Ultrasound is currently used as the first-line diagnostic tool. The differential diagnosis is often difficult when some of the smaller cavernous hemangiomas occur in the context of chronic liver disease. Most commonly, small cavernous hemangiomas are difficult to distinguish from substantial nodules of the liver. Giant cavernous hemangiomas may also be misdiagnosed as substantive liver tumors. Hepatic cavernous hemangiomas are usually asymptomatic, but slightly larger hemangiomas may have epigastric distention, dull pain, and in some female patients, symptoms may be more pronounced during menstruation. If the tumor is large, a mass may be palpable in the epigastrium, and if the tumor is exophytic and compresses the stomach, it may cause loss of appetite and indigestion. In rare cases, rupture of the tumor may cause abdominal pain, shock or even death. In large tumors, thrombocytopenia and arteriovenous shunts may affect heart function. In general, laboratory tests are mostly normal, but individual patients may have mild reduction in whole blood cells. Ultrasound examination of the upper abdomen may have the following types of echogenicity: hyperechoic: Most of them are of this type, with clear sonograms and borders, usually round or oval, and when the tumor is large, the borders may be clearly petal-like or lobulated, with scattered punctate hypoechogenicity and a few fibrous bundles of light inside, with small ductal structures entering the lesion. Hypoechoic tumors have a lower echogenic intensity than the liver parenchyma, with clear borders and regular morphology. The periphery is often seen as an enhanced thin echogenic band in the shape of a wreath with scattered strong echogenic spots or small light spots, which are often accompanied by enhancement effects in the posterior part. Mixed type: The boundary is clear but often irregular, and the sonogram shows a typical foveal network structure, which is caused by multiple reflections of blood sinus and blood. Most of them show uniform and consistent hypodense areas. Characteristic enhancement can be seen in fast enhancement scans, with full peripheral enhancement after 3-4 seconds, and after a few minutes, the density enhancement area is seen to expand toward the center, eventually reaching uniform and consistent density increase, and the duration of enhancement can be more than 3 minutes in larger tumors. The MRI is characterized by a slightly low signal in the T1 phase and a very high signal in the T2 phase, with a very bright white bulb sign. Angiography: The capillary and venous phases are continuously stained throughout, showing the “early exit and late return sign”. Once the diagnosis of hepatic cavernous hemangioma is clear, treatment may not be required, but surgery may be considered for larger tumors or those with significant symptoms. The consensus among hepatic surgeons is that radiosurgery should not be considered for hepatic cavernous hemangioma because of the poor outcome and the risk of serious complications such as ectopic embolism and severe biliary ischemic stenosis. In both cases, the subsequent treatment is very difficult. At present, laparoscopic surgery is developing rapidly, and laparoscopic resection of liver lobes such as the left half of the liver, the right half of the liver and the left outer lobe, 5 and 6 segments of the liver, or 8 segments of the liver can be performed, but there is less experience in resection of the middle lobe of the liver such as 4, 5 and 8 segments. For those with huge tumors or ruptured and bleeding tumors, open surgical resection should be performed. In conclusion, the current surgical treatment of hepatic cavernous hemangioma tends to be conservative and generally does not require treatment. For those who cannot be clearly distinguished from primary liver cancer by imaging, dynamic observation should be performed until the diagnosis is clear.