SummaryThe current status of therapy for abdominal echinococcal cysts is reviewed with emphasis on percutaneous treatment assisted by imaging techniques, mainly ultrasound (US). The percutaneous treatment under ultrasound guidance is commonly known as Puncture, Aspiration, Injection of a scolecide agent, Reaspiration (PAIR). The authors' experience with PAIR of abdominal (mostly hepatic) cysts is reported with a review of the available literature about this method. Long term results indicate that in Gharbi type I, II, and III cysts, and especially in developing countries, PAIR is the first choice method for the treatment of localized abdominal disease.