Ruptured liver metastasis with active hemorrhage has the classic appearance of a giant cavernous hemangioma on 99mTc-labeled RBC scintigraphy.

A 55-year-old woman with abdominal pain, trace hematochezia, and anemia underwent 99mTc-labeled RBC scintigraphy to assess for gastrointestinal bleeding. The patient had a remote history of malignant melanoma and had been in a motor vehicle collision 3 weeks prior. The scintigraphic findings were compatible with a giant cavernous hemangioma in the liver. A subsequent contrast-enhanced abdominal CT scan demonstrated venous extravasation into a ruptured liver metastasis.