A female infant is presented with isolated giant cutaneous cavernous hemangioma with secondary severe congestive heart failure. Studies to identify other major arteriovenous malformations were negative. An attempt to treat the patient with a corticosteroid was not successful in reducing the size of the hemangioma. She required an aggressive anticongestive medical regimen for 2 years. Though not previously described, high output congestive heart failure can occur secondary to isolated cutaneous hemangioma. Aggressive medical management may alleviate the need for the increased risk of surgical or other therapeutic approaches in this often self-limited condition.