Abstract: Primary hepatic yolk sac tumor is an extremely rare extragonadal germ cell tumor. Difficult to detect in the early stages and prone to hemorrhage and necrosis, it is a highly aggressive tumor. This study reports a case of primary hepatic yolk sac tumor in a 3-year-old girl, who presented with intermittent abdominal pain, pain in the right hypochondrium, palpitations, and shortness of breath. Computed tomography plain scan and enhanced examination revealed a space-occupying lesion in the right lobe of the liver with rupture and hemorrhage, invading the diaphragm and the right thoracic cavity. The postoperative pathological result was hepatic yolk sac tumor, and the postoperative follow-up showed that the child was in good condition. The clinical manifestations, imaging features, differential diagnosis, and treatment methods of primary hepatic yolk sac tumor summarized herein aim to provide insights that facilitate the accurate diagnosis of this disease through imaging examination methods.