Objective To investigate the diagnostic value of hepatic hemangioma with contrast-enhanced "arterial phase and / or portal vein nodular ring progressive progressive cardiac enhancement and delayed phase high or equal enhancement" for atypical hepatic cavernous hemangioma (CHL), and analysis Ultrasonographic findings and causes of hepatic cavernous hemangioma with non-characteristic angiography. Methods Retrospective analysis of 67 cases of surgically obtained ultrasonographic images of atypical lesions with cavernous hemangioma. The diagnosis of atypical choroids was performed with hemangioma characteristics and compared with pathological results, and 54 of them were performed with CT/MRI. The radiological findings were compared to evaluate the diagnostic value of contrast-enhanced angiography for atypical CHL. Results The diagnostic accuracy of contrast-enhanced ultrasonography for atypical CHL was higher than that of two-dimensional ultrasound combined with CDFI for atypical CHL (P<0.01), and ≤3 cm atypical CHL lesions were associated with >3 cm atypical CHL lesions. >3 cm atypical CHL lesions are more consistent with the typical features of hemangio CEUS performance. The accuracy of contrast-enhanced ultrasound in the diagnosis of atypical CHL was slightly higher than that of CT/MRI, but the difference was not statistically significant (P>0.05). The diagnostic accuracy of CT/MRI and contrast-enhanced ultrasound in the diagnosis of atypical CHL lesions was significantly higher than that of CT/MRI and contrast-enhanced ultrasound alone (P<0.01). In practice, the combination of ultrasound performance and biochemistry is helpful for the diagnosis of atypical CHL with contrast-enhanced ultrasound imaging. Conclusions The typical characteristics of vascular aneurysm CEUS have a high diagnostic value for atypical CHL, and its correct diagnosis rate is comparable to MRI/CT. Ultrasound combined with clinical biochemistry and radiology can improve the diagnosis of atypical CHL.