Six years old Saudi girl known case of leukodystrophy and seizure disorder She was presented to pediatric emergency department complaining of: Frequent vomiting started one day before presentation Associated with abdominal distention started suddenly as mentioned by the mother. Abdomen Ultrasound was done in Emergency Room by Pediatric Emergency Medicine fellow, upon examination huge hepatic cyst was found, with small bowel obstruction, According to the clinical history and the image findings, a hydatid cyst was suspected after that she was referred to pediatric surgery and pediatric infectious disease for further treatment. Hydatid cyst is uncommon in Saudi Arabia; it might be asymptomatic or may lead to fatal complications. The optimal treatment is considered to be surgery with the potential of removing the cyst and leading to complete cure. Making preoperative diagnosis based on the typical image findings is most important, so surgeons can take particular precaution not to rupture the lesion.