I. What are the difficulties in puncturing liver and kidney cysts? The primary prerequisite for ultrasound-guided puncture therapy is that there must be a clearly visible and safely accessible puncture path. This puncture path starts from the skin puncture point and passes through the subcutaneous tissue structures to reach the liver and kidney cysts, and the path must be able to avoid important blood vessels, organs, etc. Cysts in the medial upper pole of the kidney and in the hilum are special cases where the puncture path is more intrusive and risky. However, for an experienced interventional ultrasonographer, a safe route can be found in most cases by scanning the cyst in multiple directions, sections and angles, with a slim puncture needle, as long as there is a 2-3 mm puncture window. Therefore, as with the use of other surgical interventions, the technical level and decisiveness of the interventional physician are equally important. Of course, if it is indeed not possible, the interventionalist will always explain it in detail to the patient. In contrast, hepatic cysts are hardly more difficult. Second, what artifacts should I be aware of in liver and kidney cysts? Despite the fact that modern medical imaging technology is quite advanced and developed, the complexity of the disease and the limitations of various technologies themselves require doctors to be highly alert to prevent the trap of illusion. The greatest danger of such pseudocysts is to paralyze and mislead the interventional physicians to use sclerosing agents, which enter the bile ducts and renal pelvis and ureter through the cystic cavity, leading to serious destructive effects and unpredictable consequences. In order to strengthen the prevention, on the one hand, a comprehensive examination and evaluation of the cyst should be carried out before the puncture treatment, and the imprudent thought that “the cyst is a small case” should not be held; on the other hand, there should be a “firewall” to find out the truth in depth during the puncture operation. The direct ultrasonography of biliary tract and urinary tract (also known as non-vascular ultrasonography), which was firstly constructed by the author in 2005 in China, is a very effective “plugging network”. In addition, for liver and kidney cysts, we need to be highly alert to the possibility of cystic cancer, especially renal cystic kidney cancer often lurks in cysts, which digs an easy trap for both doctors and patients. Cystic carcinoma must be implemented as a treatment for malignancy.