A Saudi man underwent repeated percutaneous aspiration of a pleural effusion before a pleural biopsy showed hydatid disease. Subsequent investigations confirmed hydatid disease in the pleura and liver. The patient underwent surgical evacuation and irrigation of the pleural cavity followed by medical treatment for the liver cyst with albendazole, with complete recovery and disappearance of the liver cyst. The pleural cysts were enucleated and the pleural cavity was instilled with 05% silver nitrate. There was no communication through the diaphragm with the hepatic cyst and the surgeon did not attempt to remove the liver cyst because of the patient's general condition.The patient was treated with albendazole 400 mg twice daily for four weeks followed by two weeks without treatment and a further seven courses of albendazole over one year.Follow up with computed tomography and ultrasound showed regression and almost complete disappearance of the liver cyst and serial hydatid antibody titres showed a progressive fall from 1/8192 to 1/32 (negative) after one year. Forty two months after treatment the patient remained well with no recurrence of the pleural effusion.