Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible. •A diagnosis of hemangioma is established by classical imaging characteristics.•Hemangiomas with atypical imaging features may present a diagnostic dilemma.•Malignant liver lesions may display imaging features that overlap with hemangiomas.