Background Alveolar echinococcosis located in the adrenal gland can be considered a rare and aggressive infestation that radiologically and macroscopically mimics a malignant neoplasm.Its pathogenesis is poorly understood.This paper describes its clinical and radiological aspects and discusses its proper management.Methods The records of two patients with adrenal gland alveolar echinococcosis who were diagnosed and treated in our center in 2009 were evaluated.Results Neither patient showed any signs of recurrence following radical surgical treatment and postoperative oral anthelmintic therapy.Conclusion Radical surgery can be a feasible,effective management option that results in a good prospective outcome.