Background and Aims Hepatic cavernous hemangioma is the most common type of benign liver tumor. Despite the maturity of diagnostic procedures for this disease through imaging examinations, there is still a risk of misdiagnosis as hepatocellular carcinoma in cases of rare disease combinations. This article aims to provide experience and lessons for future clinical work by reviewing a case of liver transplantation diagnosed postoperatively as cavernous hemangioma combined with nodular regenerative hyperplasia, analyzing the key difficulties in the diagnosis and treatment process, reviewing the clinicopathologic characteristics of cavernous hemangioma and nodular regenerative hyperplasia, as well as their differential points from hepatocellular carcinoma and liver cirrhosis.Methods The clinical history, imaging features, and histopathological diagnosis of one liver transplant patient admitted to Zhongnan Hospital of Wuhan University hospital were retrospectively analyzed, and the diagnosis and treatment process of this case were summarized in combination with the characteristics of hepatic cavernous hemangioma and nodular regenerative hyperplasia in domestic and foreign literature.Results The patient was a 71-year-old male admitted for ascites and a space-occupying lesion in the right lobe of the liver. Imaging examinations suggested liver cirrhosis, ascites, and a space-occupying lesion in the right lobe of the liver. Abdominal CT scan and enhancement diagnosed liver cirrhosis combined with hepatocellular carcinoma. After comprehensive consultation and sufficient communication with the patient, liver transplantation was performed. Intraoperative examination and postoperative gross examination revealed diffuse nodular changes in the liver with a space-occupying lesion in the right lobe of the liver. Histologically, the former was nodular regenerative hyperplasia, while the space-occupying lesion was cavernous hemangioma.Conclusion Generally, hepatic cavernous hemangioma does not present difficulties in imaging diagnosis. However, cavernous hemangioma can still be misdiagnosed as hepatocellular carcinoma in a diffuse nodular background. Nodular regenerative hyperplasia is a rare and heterogeneous benign liver lesion with clinical features very similar to liver cirrhosis, and differentiation from the latter depends on pathological diagnosis. Even though authoritative guidelines propose that hepatocellular carcinoma can be diagnosed with imaging alone in the background of liver cirrhosis, in particular scenarios, a pre-transplantation biopsy is still required to confirm the diagnosis.