Echinococcosis (hydatidosis) remains a crucial public health concern in areas of endemicity including South Sudan. It affects mostly liver and lungs but rarely musculoskeletal system. A female, aged 75 years, presented to Kapoeta State Hospital, with a three years’ history of a painless mass on her back, gradual onset. There was no history of trauma, pain or fever. On examination there was a mass of 8cm x 5cm, soft, non-tender and lobulated on the right lower back above the gluteal region with intact skin. Imaging investigations (ultrasound, X-ray, CT scan) were not available. A provisional diagnosis of a lipoma was made. Surgery was done successfully and a hydatid cyst was found and removed. There were no post-operative complications. She was discharged on the next day with oral albendazole (400mg), twice a day for 28 days. Six months later, the patient was seen with no complains or recurrence. In endemic areas hydatid cysts should be considered in the differential diagnosis of any cystic swelling or lump. In low resource countries, incorporation of health education to school curriculum will play a key role in reducing incidence or prevalence of the disease.