Purpose: To evaluate the feasibility of percutaneous treatment of large hepatic hemangiomas (HH) by producing sclerosis through percutaneous ultrasound (US)-guided alcohol injection. The rationale of the treatment is to induce progressive thrombosis by topic endothelial damage of vascular components of the lesion, obtaining reduction of the volume, of the mass effect and of the possible complications of HH. Method/materials: Two patients, affected by giant HH diagnosed by computed tomography (CT), were elected for percutaneous treatment to avoid lobar liver resection. The first patient had HH on the VI segment (diameter 10 cm), the other patient on the left lobe (diameter 12 cm). A percutaneous needle injection of 95% sterile alcohol was performed under real-time US control. Two different areas of the lesions were injected with 10 and 20 cm 3 of alcohol, respectively. No immediate or late complications were observed and the patients experienced only minimal burn during the alcohol injection. CT scans were performed in both patients at 3, 6 and 12 months after interventional procedure in order to evaluate the efficacy of treatment. Results: Progressive thrombosis of HH was demonstrated by the serial CT controls in both cases, resulting in a significant volume reduction. Over 95% volume reduction was achieved in the first patient within 6 months and this effect still remains after 3 years. The second patient showed extensive thrombosis in the center of the lesion (>40% in volume) at 8 months control. Conclusions: Our experience demonstrates the effectiveness of percutaneous sclerosis of giant HH in order to reduce the mass effect, the compression on the surrounding liver parenchyma, limiting the risk of rupture. This treatment is a good alternative to major surgical liver resections and shows low risk, costs and minimal discomfort for the patient.