Hepatic angiomyolipoma smooth muscle lipoma is a rare mesenchymal tumor of the liver, consisting of thick-walled blood vessels, smooth muscle cells, and adipose tissue, with a potentially malignant tendency. Clinical manifestations are atypical, mostly solitary, more common in females, often asymptomatic, and some patients may present with right upper abdominal pain. Imaging examination shows that HAML has a variety of CT and MRI manifestations, and the presence of fat component is one of its characteristics. CT scan shows fat density, and enhanced CT shows significant enhancement in the arterial phase; MRI is more sensitive to the fat display, and chemical shift imaging can clarify the fat component. Dynamic enhancement MRI shows significant enhancement in the arterial phase, and the mode of enhancement in the portal or delayed phase varies according to the type. In addition, twisted blood vessels are seen in the tumor, and enhancement scans show vascular shadows within the tumor and early draining veins, which are important clues for diagnosis. Pathologically, HAML needs to be diagnosed by immunohistochemistry, and HMB-45 positivity is specific.