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Background: Infection with Echinococcus granulosus affects the liver commonly, but disseminated involvement is rare. We describe a 63 year-old man with echinococcal infection producing both hepatic and cardiac involvement that was managed surgically after failed percutaneous hepatic treatment.Methods: This report is a case study of a unique surgical problem. Various treatment modalities are reviewed.Results: The patient was a 63 year-old man from Iraq who immigrated to the United States after becoming infected with Echinococcus granulosus. He had undergone percutaneous management and albendazole therapy prior to presentation for treatment of hepatic hydatid cysts. He continued to have abdominal pain and fever and was referred to our institution. Imaging revealed persistence of the hepatic hydatid cysts, as well as a new finding of an intracardiac hydatid cyst. The patient underwent successful treatment of his complicated hepatic hydatid cysts with pericystectomy and repair of a biliary fistula. The cardiac cyst was removed as well. The patient made an uneventful recovery, and his symptoms resolved.Conclusion: Although rare, echinococcal infection may be encountered in the United States as travel increases to and from regions of the world where the disease is endemic. It is important for surgeons to be familiar with the multiple options for treatment of hydatid disease.