In this article, presented as the case of a 43-year-old patient with liver cyst posing the problem of positive diagnosis. The uncharacterizable radiology and the questionable serology have demonstrated the essential role of surgery and histological analysis in the management of this type of lesion. This case raises questions that patients and clinicians are often faced with in a hydatid disease endemic country. Through this article, we aim to discussed the latest news on diagnostic tools, the natural evolution of the disease, differential diagnoses as well as new treatment options for cystic hepatic lesion.