Abstract The clinico-radiological findings and management of 61 patients with proven hepatic echinococcal cysts (HEC) examined over the past 5 years were retrospectively analyzed. The sonography and computed tomography (CT) scan findings were studied before and after therapy. The indications, healing, and complications rates for each therapeutic modality were recorded. There is a predominance of HEC in adult females (female to male ratio, 1.77:1). The majority of patients complained of abdominal pain (39/61; 64.4%), and the majority of cysts were solitary (43/61; 70.5%), localized in the right lobe (47/61; 77.0%), and superficial (57/61; 93.4%). Few cysts were complicated by rupture, intraperitoneal (2/61; 3.2%), or intrabiliary (5/61; 8.2%). Medical treatment consisted of antihelmintic chemotherapy alone in eight patients with an adequate response in seven patients (7/8; 87.5%). Thirty-two patients had open or laparoscopic surgery with a cure rate of 50%. The other 50% had major complications requiring a further adjuvant therapy for a complete cure. Nine patients underwent percutaneous catheter ablation combined with adjuvant chemotherapy; healing was observed in eight patients (8/9; 88.8%). HEC are best treated by nonsurgical minimally invasive techniques combined with adjuvant antihelmintic chemotherapy, while surgery should be reserved for complicated HEC by intraperitoneal rupture.