Objective To summarize the contrast-enhanced ultrasound (CEUS) features of focal liver lesions which were misdiagnosed as primary hepatocellular carcinomas (HCC), and to analyze the reasons of misdiagnosis, in order to improve the diagnostic value of CEUS. Methods 132 patients with 198 focal liver lesions underwent CEUS scanning during June 2014 to October 2015. The terminal diagnoses of these lesions were confirmed by pathological and clinical diagnoses. The diagnostic efficacy of CEUS was calculated, and the reasons of misdiagnosis were summarized and analyzed. Results 28 patients without the final diagnosis were excluded. 104 patients with 138 leisions were made definite pathological and clinical diagnosis. 49 patients with 57 lesions were confirmed as HCC, and The corresponding sensitivity, specificity, positive predictive value, negative predictive value and accuracy of diagnosing HCC by CEUS were 91.23%（52/57）, 90.12%(73/81), 86.67%（52/60）, 93.59%（73/78）and 90.58%(125/138). 55 patients with 81 lesions were confirmed as other lesions, and the misdiagnosis rate of CEUS was 9.9 %（8/81）In total, 8 patients with 8 lesions were misdiagnosed as HCC by CEUS. All lesions were confirmed pathologically by percutaneous biopsy with ultrasound-guidance (n=3) and resection (n=5). All the misdiagnosed lesions showed hyper-enhancement or iso-enhancement during arterial phase and hypo-enhancement during portal or delayed phase. Conclusion Hyper or iso-enhancement during arterial phase and washout during portal or delayed phase are not particular CEUS features for HCC lesions history of hepatitis, level of tumor markers, and CT or MRI images were needed to be considered. Furthermore, in some cases the accurate diagnosis was still a real medical challenge so that a percutaneous liver biopsy was needed.