Hepatic tumors represent only 1% of all pediatric neoplasms; unfortunately, in two-thirds of cases, they are malignant. Clinical presentation is often non-specific, causing late diagnosis.

Imaging plays a fundamental role in characterizing lesions, staging and evaluating the adequate treatment and the outcome. For staging disease, The Pretreatment Extent of Disease (PRETEXT) system could be assessed using Computed Tomography (CT) or Magnetic Resonance (MR).

Main malignant liver tumors include: hepatoblastoma, hepatocellular carcinoma, fibrolamellar carcinoma, undifferentiated embryonal sarcoma, rabdomiosarcoma, epitheliod hemangioendothelioma, hepatic lymphoma, angiosarcoma, liver metastases.

Clinical and radiological features of these neoplasms are briefly reported in this pictorial review, emphasizing morphological signs observed with ultrasonography, computed tomography and magnetic resonance. However, the diagnosis could not be easy, because the majority of tumors is very often heterogeneous in appearance. A multidisciplinary approach is recommended, in order to make a correct diagnosis and help clinicians in management of patients.