Hydatidosis is a parasitic zoonosis caused by Echinococcus granulosus, still prevalent in rural areas where livestock and domestic animals coexist. Although hepatic involvement is most common, secondary pulmonary dissemination is unusual and can mimic malignancy. Early recognition in primary care is essential to prevent complications and unnecessary interventions. We present the case of a woman with a history of hepatic hydatidosis who developed multiple pulmonary lesions, initially suspected to be metastatic cancer, and who was followed for several years in coordination between primary care, internal medicine, and thoracic surgery. A 67-year-old woman, resident in a rural area and with occupational exposure in a butcher shop, consulted for chronic cough and progressive dyspnea. Chest X-ray revealed multiple nodular opacities in both lungs. CT scan showed multiple cystic lesions compatible with hydatid cysts in hepatic segments IV–VIII and numerous pulmonary nodules of varying size. Serology was positive for Echinococcus granulosus. The patient was treated with albendazole (Eskazole® 400 mg/12 h) under regular clinical and analytical monitoring. Given the diffuse pulmonary dissemination and absence of surgical indication, a conservative approach was adopted.This case illustrates an uncommon presentation of metastatic hepatopulmonary hydatidosis years after surgical treatment of hepatic cysts. The pulmonary spread simulated neoplastic metastases on imaging, representing a diagnostic challenge. Its follow-up within the framework of primary care coordination underscores the relevance of family physicians in the long-term management of chronic parasitic diseases.Primary care has a pivotal role in early suspicion, coordination with specialized care, and sustained follow-up in chronic infectious diseases. Health education and prevention—particularly in rural populations with livestock exposure—remain key strategies.Hydatidosis remains a neglected zoonosis in developed countries, often underdiagnosed. Differential diagnosis with malignant lung disease is complex, especially when lesions are multiple and bilateral. Medical treatment with albendazole can stabilize or reduce cystic lesions, although complete eradication is rare in disseminated forms. Continuous monitoring in primary care, ensuring adherence and managing comorbidities, is fundamental.Metastatic hepatopulmonary hydatidosis is a rare but important differential diagnosis of multiple lung lesions. This case highlights the value of an integrated, multidisciplinary, and long-term follow-up approach led by primary care.