The diagnosis of a simple hepatic cyst is not difficult, but diagnostic confusion occurs when atypical features such as intracystic debris or extremely large size are present. In children, simple liver cysts are described as small, asymptomatic, and rarely hemorrhagic. We report an adolescent male presenting with an unusually large hepatic cyst that did not have typical imaging characteristics. The imaging findings and histology are displayed along with the differential diagnoses of complex liver cysts.