Primary pulmonary choriocarcinoma is a very rare and poorly prognostic tumor. Due to its nonspecific clinical symptoms and radiological resemblance to infections and other malignancies, it can often be misdiagnosed or diagnosed late and there is no standart treatment protocol. Here, we presented a case of a 40-year-old male with a history of tuberculosis who presented with hemoptysis and dyspnea, where imaging revealed a significant cavitary mass in the right lung, along with nodular and cystic lesions. The initial diagnosis suggested hydatid cyst; however, further evaluation, including pathological and immunohistochemical studies on resection material ultimately identified the cystic lesion as choriocarcinoma, confirmed by elevated levels of β-human chorionic gonadotropin in the postoperative period. Despite advanced imaging techniques, serological tests; primary pulmonary choriocarcinoma is frequently misdiagnosed, necessitating a high index of suspicion. Early recognition and appropriate management are critical for improving patient outcomes in this aggressive tumor type.