Background: Focal hepatic lesions, in the pediatric population, form a unique and distinct spectrumwhich constitute about 5-6% of all intra-abdominal masses in children. Imaging is astandard part of the evaluation of pediatric liver masses. Routine use of ultrasonography ingeneral pediatric practice, even following very mild and nonspecific abdominal symptoms,has dramatically increased the detection of focal hepatic lesions. They range from entirelybenign incidental lesions to malignant tumors and on most occasions warrant further diagnosticwork-up, including computed tomography [CT] and magnetic resonance imaging [MRI].Objectives: The primary aim of this study is to assess the frequency, aetiology and clinicalpresentation of focal hepatic lesions among infants and children, from a pediatric hepatologistperspective. The secondary aim is to construct a workup for their diagnosis and management.Methods: We conducted a retrospective review of children with focal hepatic lesions referred tothe Pediatric Hepatology clinic, Cairo University Pediatric Hospital during the period 2006–2010.Results: Focal hepatic lesions were detected in 28 patients (0.8%) from a total of 3625 patientspresented to our clinic during the period of study. Of these lesions, 22 (79%) were benign,and 6 (21%) were malignant. Eight patients (29%) had infantile hepatic hemangioma, 5(18%) had abscesses and 4 (14%) had hepatocellular carcinoma. The remainder of the lesionswere 3 fasciola, 3 simple cysts, 3 mesenchymal hamartoma, and one each of hepatoblastomaand leukemia. The mean age at presentation was 2.7 years, and 19 (68%) were males. Lesionswere initially noticed on imaging studies performed for unrelated symptoms in 17 children(61%), symptoms and laboratory abnormalities consistent with liver disease in 8 (28%),and palpable abdominal masses in 3 (11%). Of the 28 patients, 10 (36%) were under observationwhile medications targeting lesions were used in 12 (43%). Surgical treatment was donein 5 (18%) patients and liver transplantation was performed in 1. Conclusion: Infantile hepatic hemangioma was the most common focalhepatic lesion. The ma-jority of lesions were found incidentally. Lesionswere diagnosed radiologically by ultra-sound and CT. Medical treatmentwas used in most patients, while expectant management was sufficient insome patients. Surgical intervention including transplantation was occasionallyneeded.