Hypoechoic areas of the liver, most commonly hepatic cysts, are specifically congenital and acquired. Acquired hepatic cysts mainly occur in the pastoral area and are formed after being infected by parasites and should be treated with early elective surgery. Congenital hepatic cysts are considered to be caused by bile duct dilatation, and patients usually have no symptoms, many of them are found during physical examination, showing round-like hypodense changes in the liver with smooth margins and non-enhancing contrast on enhanced examination. Huge liver cysts are prone to secondary infections and compression of adjacent organs, and even obstruction and jaundice, requiring prompt surgical treatment of choice, either by removal of the cyst or drainage.