Objective: The case report presents the patient with hydatid cyst of Echinococcus multiocularis located in the adrenal gland. Hydatid cysts in adrenal glands occur very rarely, and symptoms are nonspecific. The aim of this case report is to draw attention to atypical causes of arterial hypertension. Design and method: Th case report of the male-patient with Echinococcus multiocularis hydatid cyst in right adrenal gland complicated with extensive thrombosis of inferior vena cava and both renal veins, as well as right hepatic vein with preserved marginal flow and developed collateral circulation. Results: 32-year-old man, with a history of arterial hypertension treated since 3 weeks was admitted to the Department of Internal Medicine and Hypertension due to chest pain and peripheral oedemaMoreover, patient reported lower back pain and high blood pressure values despite of multidrug therapy. Laboratory tests indicated elevated creatinine level and proteinuria. An ultrasound examination revealed kidney enlargement and suspicion of right renal artery stenosis, prompting further investigation. Angio-CT of the abdomen and pelvis uncovered a contrast-enhanced polycyclic mass with calcifications in the right adrenal gland and several similar lesions in the liver, some of which had star-shaped calcifications. The imaging also revealed extensive thrombosis in the inferior vena cava, renal veins, and right hepatic vein, with preserved marginal flow and developed collateral circulation. The patient was started on therapeutic anticoagulation with low molecular weight heparin. After performing a series of diagnostic tests and consultations, the infection of Echinococcus multilocularis was diagnosed by serological tests. Albendazole in a dose of 400 mg twice a day was added to the therapy. The patient's condition remained stable, and surgical removal of the cysts was planned. Conclusions: The case shows how important is collaboration between specialists. Holistic approach to patient enabled to find out the cause of high blood pressure. It was renal vein thrombosis due to Echinococcus multiocularis infection.