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Congenital hepatic cysts are usually asymptomatic, very rare conditions in infancy and are most often discovered incidentally during radiologic imaging. They are more common in females with no racial differences. Most simple hepatic cysts are small and disappear spontaneously but in about 15% of cases, the cysts may be large and compress on adjacent structures leading to different clinical manifestations. We present a 10month old girl who presented with abdominal swelling, fever, pallor and difficulty with breathing. An abdominal CT scan confirmed congenital hepatic cyst which was managed by percutaneous needle aspiration and sclerotherapy alongside nutritional intervention for severe malnutrition.