Liver cysts are more common benign liver diseases and are classified as parasitic and non-parasitic liver cysts. The latter are subdivided into congenital, traumatic, inflammatory and neoplastic cysts. Congenital hepatic cysts are mostly seen clinically and can be subdivided into monogenic and multiple. Congenital hepatic cysts are more common in females. Most patients have no symptoms and are only detected during ultrasound examinations or abdominal surgery. Symptoms are mostly caused by large cysts, pulling the liver envelope or compressing adjacent organs. Common symptoms include epigastric discomfort, vague pain, postprandial fullness, loss of appetite, nausea, vomiting, and epigastric masses. Huge cysts may cause dyspnea, portal hypertension and jaundice. Rupture of the cyst or intracapsular hemorrhage or torsion of the cyst with a tip may cause sudden onset of epigastric pain. Infection in the cyst may cause chills and fever. Physical examination may reveal a large hepatic or right upper abdominal mass with cystic sensation, smooth surface and no pressure pain. A large cyst may have a markedly enlarged abdomen. For most asymptomatic cysts with no significant changes on ultrasound follow-up no treatment is needed, only regular observation is required. Treatment can be considered for larger cysts that produce symptoms by compression of adjacent organs.