Objective To investigate the causes of misdiagnosis of hepatocellular carcinoma (HCC) as focal nodular hyperplasia (FNH) , and to evaluate potential differential diagnostic features between the two diseases.Methods Retrospective analysis was carried out for five patients initially diagnosed with FNH and confirmed as HCC after surgery between January 2008 and December 2011.Results The liver masses were initially indicated by ultrasound examination showing low echo areas or echo intensity inequality.Three of the cases underwent enhanced computed tomography (CT) examination, and two cases underwent enhanced magnetic resonance imaging (MRI) examination.A central scar was present in some of the cases.All of the cases were diagnosed with FNH by imaging findings and underwent surgical resection, after which pathology findings confirmed the HCC diagnosis.Conclusion The diagnosis of FNH in patients with hepatitis should be carefully considered for differential diagnosis of HCC.Imaging findings from enhanced CT and MRI may provide reveal differential features.