The increasing popularity of social media promotes the proliferation of fake news, which has caused significant negative societal effects. Therefore, fake news detection on social media has recently become an emerging research area of great concern. With the development of multimedia technology, fake news attempts to utilize multimedia content with images or videos to attract and mislead consumers for rapid dissemination, which makes visual content an important part of fake news. Despite the importance of visual content, our understanding of the role of visual content in fake news detection is still limited. This chapter presents a comprehensive review of the visual content in fake news, including the basic concepts, effective visual features, representative detection methods and challenging issues of multimedia fake news detection. This chapter can help readers to understand the role of visual content in fake news detection, and effectively utilize visual content to assist in detecting multimedia fake news.