Giant hemangiomas of the liver are clinically distinct from smaller and more innocent hemangiomas as they are more prone to complications. On imaging with ultrasound, they can also be readily confused with hepatoma, metastatic disease, or focal nodular hyperplasia. Nine giant hemangiomas (maximal diameter greater than 8 cm) were studied by scintigraphy and ultrasound. In all instances, the fill-in of the lesion on [99mTc]RBC scintigraphy indicated the diagnosis of hemangioma, adding specificity to the screening sonographic study. The pattern of fill-in on scintigraphy also appeared to be size dependent with lesions less than 11 cm in diameter equilibrating uniformly, while larger abnormalities intensified in centripetal fashion.