A retrospective review of the sonographic appearances of 29 proved atypical hemangiomas in 29 patients and a prospective study of the predictive capacity of these features were performed. The main confirmatory imaging examinations were computed tomography and technetium-labeled red blood cell radioisotope scanning with single photon emission computed tomography. The retrospective review showed that all tumors were solid. Twenty-seven tumors had an echogenic border, seen as a thick echogenic rind (n = 15) and a thin rim (n = 12). Unlike typical hemangiomas, which have a uniformly increased echogenicity relative to normal liver, all 29 tumors had an internal echo pattern that was at least partially hypoechoic. These morphologic criteria (a solid tumor with an echogenic border and partially hypoechoic internal pattern) were then prospectively applied to all hepatic tumors detected with sonography during a 6-month period. Fifteen lesions with these features were identified from among more than 5,000 abdominal scans. Twelve of these lesions were confirmed as, and two were presumed to be, cavernous hemangiomas; in one lesion, the diagnosis was false-positive. Recognition of these atypical features should increase suspicion of the presence of hemangiomas on sonograms.