Background: Infantile hepatic hemangioma (IHH) as a benign liver tumor in infancy and childhood is commonly associated with high output cardiac failure. The present study aims to describe the imaging findings in a patient who was diagnosed as having multiple IHH with congestive cardiac insuffi ciency. Methods: The imaging findings and clinical manifestations of the patient with multiple IHH associated with cardiac insuffi ciency were retrospectively reviewed. Results: Ultrasonography showed multiple intrahepatic lesions with mixed echoes and markedly expanded hepatic veins and the inferior vena cava of the patient. Echocardiography revealed right heart insufficiency and pulmonary hypertension. Contrast-enhanced MRI showed early mild enhancement of lesions and more obvious delayed enhancement. The patient died after combined therapy of surgery and hormone. Conclusions: The imaging findings of multiple IHH associated with cardiac insufficiency are typical and diagnostic. Early imaging assessment may facilitate the diagnosis and treatment of the disease.