Hepatic mesenchymal hamartoma (HMH) is a rare benign liver tumor that predominantly affects children under the age of 2. Clinically, there may be an elevation in alpha-fetoprotein levels, which can lead to a mistake diagnosis of malignant tumor. HMHs primarily occur in the right lobe of the liver and are characterized by multilocular cystic structures separated by mucoid connective tissue containing stellate mesenchymal cells. Of note, in a few cases HMH can transform into an undifferentiated embryonal rhabdomyosarcoma. Imaging examinations play a crucial role in diagnosing, determining the extent, and guiding treatment. Typically, HMHs manifest as large atrial cystic masses with low vascularity. However, atypical features such as highly vascularized or solid masses, small cystic cavities, or isolated large cystic cavities need to be differentiated from other diseases presenting similar characteristics.