ArcGIS 10 has had issues with ecw file formats so maybe this is another. Having said that, a 5GB ecw, sid or jp2 at typical 1:20 compression, is a huge file, and probably has to be decompressed to the full 20 GB size before it can be processed. That may just be too much for the computer and/or software. If you can get it to display in a project, you might: 1) use a clip option in the data frame properties to limit its display, 2) create a masking polygon that you place over it in the TOC to limit its display, 3) export directly to a preferred file format with georeferencing from the view, perhaps in smaller pieces that can be mosaiced, to provide enough resolution, or 4) export from a layout to a preferred raster format and then georeference that.
You might also try other programs like the LizardTech Geoviewer (free) and see if it can save to a different format.