Whether it matters if you have cysts in hepatitis B is related to the nature of the cysts and has little to do with hepatitis B. Cystic lesions of the liver are a heterogeneous group of disorders with differences in etiology, prevalence and clinical presentation. Most hepatic cysts are true cysts found incidentally on imaging and tend to have a benign course. A small number of liver cysts can cause symptoms and, in rare cases, serious complications or even death. Larger cysts are more likely to cause symptoms and complications, including spontaneous bleeding, rupture into the abdominal cavity or biliary tract, infection, and compression of the biliary tree. Certain cystic lesions of the liver may have unique complications, such as mucinous cystic neoplasm (MCN, i.e., cystadenoma) or malignant transformation of a ciliated prehepatic intestinal cyst or anaphylactic shock caused by an echinococcal cyst. Some of these complications may sometimes require surgical intervention. Most patients with simple hepatic cysts are asymptomatic and, because they have no malignant potential, do not require treatment or follow-up. In patients with larger and symptomatic simple cysts, the choice of intervention varies from patient to patient, depending on the location and size of the cyst, the patient’s history and comorbidities, local expertise, and the patient’s wishes. For patients who are suitable for surgery, laparoscopic or open cyst decortication is usually curative. For patients who cannot or do not wish to undergo surgical intervention, percutaneous aspiration combined with sclerotherapy (PAS) is feasible.