Cystic lesions of the liver are a common finding and the differential diagnosis is wider than often considered. When a hepatic cystic lesion is identified at imaging, the differential diagnosis may be broad, including developmental, infectious, neoplastic, and post-traumatic or iatrogenic causes. Awareness of the radiologic key features allows a correct presumptive diagnosis in a lot of cases. The location of a cystic lesion and its number, size, composition, and relationship to the biliary system are features that help in narrowing the differential diagnosis. An incidentally detected simple hepatic cyst is the most commonly encountered. The presence of multiple cysts should raise suspicion for fibropolycystic liver disease, a group of related lesions-including biliary hamartoma and choledochal cyst-caused by abnormal embryologic development of the ductal plate. Communication of the cystic lesion with the biliary tree can confirm the diagnosis of a choledochal cyst. Familiarity with imaging findings and clinical features is essential for achieving accurate diagnosis of hepatic cystic lesions, which in turn can guide appropriate clinical management. Diagnostic accuracy is increased when combining the characteristic radiologic features with the clinical history and laboratory findings. Further useful information can be obtained in the most difficult cases with atypical findings using fine needle aspiration performed under imaging guidance.