Hydatid disease remains a significant public health concern in endemic countries such as Tunisia. Among its rare but serious complications is the rupture of a liver hydatid cyst into the inferior vena cava (IVC), leading to a wide range of clinical presentations and outcomes. This article reports 2 illustrative cases. The first involves a 45-year-old patient with recurrent right hypochondria pain, where imaging revealed a 6 cm liver cyst near the IVC. Surgical management included cyst resection and kysto-caval fistula repair, followed by recovery from a postoperative infection. The second case describes a 60-year-old woman with comorbidities, presenting with dyspnea and pain, where imaging showed multiple thromboses and a hepatic cyst; she was successfully managed conservatively with anticoagulants and Albendazole. These cases underscore the importance of timely diagnosis and tailored treatment for this rare but potentially life-threatening condition.