Cystic echinococcosis, a neglected tropical disease caused by Echinococcus granulosus, is of One-Health importance. The disease has significant impact on the economy of Pakistan, where livestock is an important pillar of farming. Given the large socio-economic and zoonotic importance of cattle, we explored echinococcosis prevalence in livestock, focusing on three previously little-studied districts of Punjab (Narowal, Sheikhupura and Sialkot), Pakistan. We screened in total 1168 slaughtered cattle for presence of hydatid cysts. The collected hydatid cysts were subjected to microscopy, histopathology, and PCR. Overall disease prevalence was 7.7% (n=1168), significantly higher in Narowal (9.6%) than in Sheikhupura (7.6%) and Sialkot (5.7%). The oldest cattle group (>5 years) had significantly higher prevalence (11.8%) than younger animals (6.8% in 3-5-year and 4% in 1-3-year-olds). Females had significantly higher prevalence (9.1%) than male (4.9%) cattle. Significantly more cysts occurred in cattle lungs (71.4%) rather than the liver (28.5%), and the number of fertile cysts was significantly higher in lungs (56.9%) compared to liver (50%). PCR and sequencing of one cyst confirmed the species to be Echinococcus granulosus, with phylogenetic analysis clustering our ND1 sequence with the G1-G3 lineages. We found hydatid cysts to cause histopathological changes in the host tissue surrounding the cysts, including atrophy, fibrosis, cell degeneration and leucocytic infiltration. General Linear Models revealed that animals (cattle and dogs) kept near slaughterhouses, particularly in urban and semi-urban areas, significantly increased the risk of cystic echinococcosis in cattle. Based on these findings, we recommend a public health campaign to increase awareness of zoonotic infections.