The liver is the most commonly affected organ, with complications like cyst rupture, hematogenous spread and infection. Imaging techniques such as ultrasound, CT and MRI play a vital role in diagnosing and classifying the disease, facilitating the appropriate therapeutic approach. Serology has only a confirmational role after imaging [1].

Ultrasound depicts calcification and is often used as a screening tool because it is not only highly sensitive and specific but also non-invasive, widely available and a cost-efficient mode of investigation. The cyst wall typically appears as two echogenic lines with a hypoechogenic fluid layer in between. Simple cysts lack internal structures but a hydatid cyst may show echogenic foci, known as hydatid sand, that shifts to the lowest part of the cyst when the patient is repositioned. This movement creates the snowstorm sign, where the foci appear scattered like a snowstorm, without forming distinct layers. Water lily sign on ultrasound, CT and MRI is used for describing the detachment of the membrane inside the cyst. Depending on the membrane configuration, it can also be observed as the snake sign (also called the serpent sign) [2].

CT, with its high sensitivity and specificity, is an effective method for describing rupture, infection, calcification and extrahepatic spread. On the other hand, MRI is a modality of choice for biliary complications. CT depicts air-fluid levels in case of infection or perforation into hollow viscera. It is a modality of choice in case of peritoneal seeding because it enables the imaging of the whole abdomen. CT is not suitable for staging of the hydatid disease. To classify the disease, WHO-IWGE-Classification is commonly applied. WHO-IWGE-Classification grades the cyst into six stages; with CE1-CE2 as active, CE3A-CE3B as transitional and CE4-CE5 as inactive stages [3].