Cystic lesions of the liver are a common finding and the differential diagnosis is wider than often considered. Awareness of the radiologic key features allows a correct presumptive diagnosis in a lot of cases. Diagnostic accuracy is increased when combining the characteristic radiologic features to the clinical history and laboratory findings as summarized in Table I. Further useful information can be obtained in the most difficult cases with atypical findings by means of fine needle aspiration performed under imaging guidance. In endemic regions, hepatic echinococcal cyst should be always kept in mind and excluded from the differential diagnosis of HCL.