Objective To analyze the atypical CT findings of small hepatocellular carcinoma, so as to improve the accuracy of diagnosis. Methods A retrospective analysis was performed on 18 cases of atypical small hepatocellular carcinoma that were pathologically confirmed between January 2010 and November 2016 in our hospital. Results All the cases were single lesions, and the CT manifestations were divided into the following 11 types: 1) 5 cases of low density-arterial phase high density-portal phase high density. 2) two cases of low density-arterial high density (close to the same level of aorta)-portal low density. 3) 1 case with low density - arterial phase high density - portal phase equal density. 4) 2 cases with low density at the edge of arterial stage and low density at the edge of plain scanning, with incomplete ring. 5) 1 case with low density - arterial edge annular density, incomplete ring, nodular-portal ring and nodular density. 6) two cases of low density - arterial low density-portal low density were swept. 7) 1 case with low density-arterial phase low density-portal phase equal density. 8) 1 case presented low density in the scanning low-arterial isopyme-portal period. 9) one case of isodensity-low density in arterial phase - low density in portal phase. 10) one case of isodensityarterial density-portal density. 11) 1 case with histological density - arterial density-portal density. The higher arterial density was lower than that of the same aorta and higher than that of the liver. Conclusion The dynamic enhanced CT scan of small hepatocellular carcinoma has a variety of atypical enhanced manifestations, and the correct recognition of these atypical enhanced manifestations can reduce the misdiagnosis rate.