Primary pulmonary choriocarcinoma is a very rare tumor with a poor prognosis. Due to its non-specific clinical presentation and radiological similarities to infections and other malignancies, it is often misdiagnosed or diagnosed late. Furthermore, there is no standardized treatment protocol. We present the case of a 40-year-old male with a history of tuberculosis who was admitted with hemoptysis and dyspnea. Imaging revealed a large cavitary mass in the right lung, along with nodular and cystic lesions. The initial diagnosis suggested a hydatid cyst; however, further evaluation, including pathological and immunohistochemical analysis of the resected tissue, ultimately identified the cystic lesion as choriocarcinoma. This diagnosis was confirmed by elevated levels of β-human chorionic gonadotropin in the postoperative period. Despite advances in imaging and serologic testing, PPC is frequently misdiagnosed, highlighting the need for a high index of suspicion. Early recognition and appropriate management are essential to improve outcomes in this aggressive tumor.