We report the cases of two women coming from rural areas affected by hydatid disease of the liver that presented with right upper quadrant pain. In both cases the cyst was ultrasonographically classified, according to the WHO classification system, as type CE5, meaning an inactive status with thick calcified walls and without living protoscolices. MRI did not demonstrated any cysto-biliary communication. CT-scan defined anatomy and relationship of the cysts with the surrounding structures. In the first case, the cyst appeared located in segment 7, causing compression on the right hepatic vein. In the second case, the cyst was located in segment 5, adjacent to a gallbladder full of gallstones. Both patients began Albendazole in prophylaxis and were proposed for surgery. In the first case we decided for an open approach, being the cyst posterior in position and dramatically close to the right hepatic vein. The second case was treated, instead, with a laparoscopic pericystectomy, considered the anterior and peripheral position that could allow for a safe and controlled resection. We protected the operative field with gauzes soaked with 20% hypertonic solution. Intraoperative ultrasound was important to define cystic extension and its relationships with the close structures. In the first case, the right hepatic vein was eventually safely skeletonized while, in the second case, a branch of the median hepatic vein and the right anterior branches were ligated. Radical excision was successfully accomplished and both patients were discharged on the 6th post-operative day. Hystology confirmed Echinococcus granulosus etiology of the cyst.