Echinococcosis presenting as acute abdominal pain

We present the case of a 71-year-old man with hydatid disease who travels frequently to and from the United States and Mexico. He presented to the emergency department (ED) with a chief complaint of acute abdominal pain accompanied by neurological and urinary symptoms. A large cystic mass was found in the abdomen, as well as multiple metastases secondary to prostate cancer. Limited availability of history and lack of compliance in the past led to the unusual presentation of this patient. Challenges to diagnosis are discussed.