diff --git a/litellm/main.py b/litellm/main.py
index ea41919e19e..65c00163f91 100644
--- a/litellm/main.py
+++ b/litellm/main.py
@@ -7185,6 +7185,23 @@ def stream_chunk_builder(  # noqa: PLR0915
             _choice = cast(Choices, response.choices[0])
             _choice.message.audio = processor.get_combined_audio_content(audio_chunks)
 
+        # Handle image chunks from models like gemini-2.5-flash-image
+        # See: https://github.com/BerriAI/litellm/issues/19478
+        image_chunks = [
+            chunk
+            for chunk in chunks
+            if len(chunk["choices"]) > 0
+            and "images" in chunk["choices"][0]["delta"]
+            and chunk["choices"][0]["delta"]["images"] is not None
+        ]
+
+        if len(image_chunks) > 0:
+            # Images come complete in a single chunk, collect all images from all chunks
+            all_images = []
+            for chunk in image_chunks:
+                all_images.extend(chunk["choices"][0]["delta"]["images"])
+            response["choices"][0]["message"]["images"] = all_images
+
         # Combine provider_specific_fields from streaming chunks (e.g., web_search_results, citations)
         # See: https://github.com/BerriAI/litellm/issues/17737
         provider_specific_chunks = [
diff --git a/tests/litellm/test_stream_chunk_builder_images.py b/tests/litellm/test_stream_chunk_builder_images.py
new file mode 100644
index 00000000000..c51a14ede67
--- /dev/null
+++ b/tests/litellm/test_stream_chunk_builder_images.py
@@ -0,0 +1,242 @@
+"""
+Test that stream_chunk_builder correctly preserves images from streaming chunks.
+
+This tests the fix for https://github.com/BerriAI/litellm/issues/19478
+where images from models like gemini-2.5-flash-image were lost when
+rebuilding the response from streaming chunks.
+"""
+import pytest
+import litellm
+from litellm import stream_chunk_builder
+
+
+def test_stream_chunk_builder_preserves_images():
+    """
+    Test that stream_chunk_builder correctly preserves images from streaming chunks.
+    """
+    # Simulate streaming chunks from an image generation model
+    init_chunks = [
+        {
+            "id": "chatcmpl-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {
+                        "role": "assistant",
+                    },
+                    "finish_reason": None,
+                }
+            ],
+            "created": 1737654321,
+            "model": "gemini/gemini-2.5-flash-image",
+            "object": "chat.completion.chunk",
+        },
+        {
+            "id": "chatcmpl-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {
+                        "images": [
+                            {
+                                "image_url": {
+                                    "url": "data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+M9QDwADhgGAWjR9awAAAABJRU5ErkJggg==",
+                                    "detail": "auto"
+                                },
+                                "index": 0,
+                                "type": "image_url"
+                            }
+                        ],
+                    },
+                    "finish_reason": None,
+                }
+            ],
+            "created": 1737654321,
+            "model": "gemini/gemini-2.5-flash-image",
+            "object": "chat.completion.chunk",
+        },
+        {
+            "id": "chatcmpl-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {},
+                    "finish_reason": "stop",
+                }
+            ],
+            "created": 1737654321,
+            "model": "gemini/gemini-2.5-flash-image",
+            "object": "chat.completion.chunk",
+        },
+    ]
+
+    chunks = []
+    for chunk in init_chunks:
+        chunks.append(litellm.ModelResponse(**chunk, stream=True))
+
+    response = stream_chunk_builder(chunks=chunks)
+
+    # Verify that images are preserved in the rebuilt response
+    assert response.choices[0].message.images is not None, "Images should be preserved in stream_chunk_builder"
+    assert len(response.choices[0].message.images) == 1, "Should have exactly 1 image"
+    assert response.choices[0].message.images[0]["type"] == "image_url"
+    assert "base64" in response.choices[0].message.images[0]["image_url"]["url"]
+
+
+def test_stream_chunk_builder_preserves_multiple_images():
+    """
+    Test that stream_chunk_builder correctly preserves multiple images from different chunks.
+    """
+    init_chunks = [
+        {
+            "id": "chatcmpl-multi-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {
+                        "role": "assistant",
+                        "content": "Here are your images:",
+                    },
+                    "finish_reason": None,
+                }
+            ],
+            "created": 1737654321,
+            "model": "gemini/gemini-2.5-flash-image",
+            "object": "chat.completion.chunk",
+        },
+        {
+            "id": "chatcmpl-multi-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {
+                        "images": [
+                            {
+                                "image_url": {"url": "data:image/png;base64,image1data", "detail": "auto"},
+                                "index": 0,
+                                "type": "image_url"
+                            }
+                        ],
+                    },
+                    "finish_reason": None,
+                }
+            ],
+            "created": 1737654321,
+            "model": "gemini/gemini-2.5-flash-image",
+            "object": "chat.completion.chunk",
+        },
+        {
+            "id": "chatcmpl-multi-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {
+                        "images": [
+                            {
+                                "image_url": {"url": "data:image/png;base64,image2data", "detail": "auto"},
+                                "index": 1,
+                                "type": "image_url"
+                            }
+                        ],
+                    },
+                    "finish_reason": None,
+                }
+            ],
+            "created": 1737654321,
+            "model": "gemini/gemini-2.5-flash-image",
+            "object": "chat.completion.chunk",
+        },
+        {
+            "id": "chatcmpl-multi-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {},
+                    "finish_reason": "stop",
+                }
+            ],
+            "created": 1737654321,
+            "model": "gemini/gemini-2.5-flash-image",
+            "object": "chat.completion.chunk",
+        },
+    ]
+
+    chunks = []
+    for chunk in init_chunks:
+        chunks.append(litellm.ModelResponse(**chunk, stream=True))
+
+    response = stream_chunk_builder(chunks=chunks)
+
+    # Verify content is preserved
+    assert response.choices[0].message.content == "Here are your images:"
+
+    # Verify all images are preserved
+    assert response.choices[0].message.images is not None, "Images should be preserved"
+    assert len(response.choices[0].message.images) == 2, "Should have exactly 2 images"
+    assert "image1data" in response.choices[0].message.images[0]["image_url"]["url"]
+    assert "image2data" in response.choices[0].message.images[1]["image_url"]["url"]
+
+
+def test_stream_chunk_builder_no_images():
+    """
+    Test that stream_chunk_builder works correctly when there are no images (regression test).
+    """
+    init_chunks = [
+        {
+            "id": "chatcmpl-no-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {
+                        "role": "assistant",
+                        "content": "Hello, ",
+                    },
+                    "finish_reason": None,
+                }
+            ],
+            "created": 1737654321,
+            "model": "gpt-4",
+            "object": "chat.completion.chunk",
+        },
+        {
+            "id": "chatcmpl-no-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {
+                        "content": "world!",
+                    },
+                    "finish_reason": None,
+                }
+            ],
+            "created": 1737654321,
+            "model": "gpt-4",
+            "object": "chat.completion.chunk",
+        },
+        {
+            "id": "chatcmpl-no-image-test",
+            "choices": [
+                {
+                    "index": 0,
+                    "delta": {},
+                    "finish_reason": "stop",
+                }
+            ],
+            "created": 1737654321,
+            "model": "gpt-4",
+            "object": "chat.completion.chunk",
+        },
+    ]
+
+    chunks = []
+    for chunk in init_chunks:
+        chunks.append(litellm.ModelResponse(**chunk, stream=True))
+
+    response = stream_chunk_builder(chunks=chunks)
+
+    # Verify content is preserved
+    assert response.choices[0].message.content == "Hello, world!"
+
+    # Verify images attribute doesn't exist or is None (no images in this stream)
+    images = getattr(response.choices[0].message, 'images', None)
+    assert images is None, "Should not have images when none were in the stream"