PURPOSE: To evaluate whether the presence of a peripheral echogenic rim surrounding internal low echogenicityis helpful in the diagnosis of atypical hepatic hemangioma. MATERIALS AND METHODS: Within a two-year period, aretrospective review of the sonographic appearances of 24 atypical hemangiomas in 21 patients was performed. Diagnosis was made by dynamic and delayed enhanced CT, MR imaging or clinical follow up for one year, including follow-up sonogram. The sonographic appearances of these hemangiomas were analyzed for pattern and thickness ofthe echogenic rim, internal echo pattern, shape, and size. Additionally, forty six lesions of hepatoma, metastasis, abscess and intrahepatic cholangiocarcinoma confirmed by pathology within the same period were also evaluated for the presence of echogenic rim. RESULTS: Twenty-three of 24 lesions showed an echogenic rim ; these were thick in nine cases, and thin in 14 cases. The thickness of the rim was either uniform(n=10) or eccentric(n=13). The average maximum diameter of atypical hemangioma was 4.4cm (range of diameters, 1.5-12cm). The internal echo pattern was partially or entirely hypoechoic in 15 lesions, homogeneously isoechoic in three, and mixed insix cases. Twenty-one lesions were round, and the shape of three was irregular. The other forty six masses including hepatocellular carcinoma, metastases, cholangiocarcinoma and hepatic abscesses did not show an echogenicrim. CONCLUSIONS: The presence of a sonographic echogenic rim in a hepatic mass may help in the diagnosis ofhepatic hemangioma.