Congenital hepatic cysts are a frequent disease, symptomatic in 16-18% of the cases. The Authors report their personal experience about 4 cases and they make a review about 56 cases treated with ultrasonically-guided therapy. In 20 cases the therapy was simple aspiration, in 39 was alcohol sclerotherapy and in 1 was external percutaneous drainage. All the 20 cysts treated with simple aspiration recurred after 0.5-24 months. All the 39 patients treated with alcohol sclerotherapy presented a complete remission of symptoms and are disease-free after 1-48 months. The patient treated with percutaneous drainage, is disease-free after 10 months from the procedure. The alcohol sclerotherapy is the treatment of choice for the congenital hepatic cysts. The simple aspiration is an effective procedure only from a diagnostic point of view but not therapeutic. The external percutaneous drainage is the treatment of choice in case of infected cysts. Surgery is indicated only in the cysts with acute presentation, with biliary content and in case of failure of alcohol sclerotherapy.