<p>Focal cystic liver lesions are commonly encountered in routine clinical practice. They represent a broad spectrum of etiologies and can be classified into congenital/developmental, infectious/inflammatory, neoplastic and miscellaneous conditions. As the clinical implications and management strategies differ markedly depending on the underlying etiology, accurate differentiation among the various types of cystic focal liver lesions is of paramount importance. Radiologists should systematically evaluate imaging characteristics, including lesion location, size, presence of septa , and whether the cysts are solitary or multiple, while also assessing cyst complexity and any associated imaging findings. Given the considerable overlap in imaging appearances among cystic liver lesions, correlation of radiologic findings with the clinical presentation and laboratory data is essential to establish a definitive diagnosis or provide a reasonable list of differential diagnoses.</p>