The sonograms of five patients with a diagnosis of infantile hepatic hemangioma were retrospectively reviewed to analyze their sonographic and Doppler characteristics. Three patients had single lesions, whereas two had multifocal involvement. All lesions except one were hypoechoic, well-circumscribed, and solid; the exception was hyperechoic. Findings of high flow, ie, large draining veins, an abrupt change in aortic caliber, and the presence of Doppler signal throughout the lesion were seen in three of five patients. The sonographic findings correlate well with the pathologic findings of multiple vascular channels separated by fibrous septa. The major differential diagnosis of infantile hepatic hemangioma includes hepatoblastoma and metastatic neuroblastoma. Although some of their sonographic features may simulate a hemangioma, large draining veins and changes in aortic caliber are not reportedly seen. Doppler flow was not seen in either of these malignant neoplasms in our study and, to date, has only been reported peripheral to three cases of hepatoblastoma and not at all in metastatic neuroblastoma. We propose an algorithmic approach dependent upon the sonographic-Doppler appearance.