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Abstract Background Gestational choriocarcinoma is the most common gestational trophoblastic neoplasia; it is often secondary to hydatidiform mole, as well as to abortion, ectopic pregnancy, premature delivery, or term delivery. Approximately 60% of patients with choriocarcinoma develop pulmonary metastases, but for patients with a respiratory condition, choriocarcinoma with lung metastasis is a relatively rare lung cancer diagnosis. Three cases of choriocarcinoma with pulmonary metastasis who had the primary symptom of hemoptysis are described. Case presentation This case report describes a 35-year-old Chinese woman of Han nationality, a 23-year-old Chinese woman of Han nationality, and a 46-year-old Chinese woman of Han nationality whose primary symptom was hemoptysis and different chest imaging manifestations; they were finally diagnosed as having pulmonary metastatic choriocarcinoma. All patients had low risk factors, including abortion, hydatidiform mole, and ectopic pregnancy. Human chorionic gonadotropin played an important role in choriocarcinoma diagnosis. Conclusions Based on the diagnosis and treatment of the three patients, we suggested that for women with pregnancy history and hemoptysis (particularly in the presence of risk factors such as abortion, hydatidiform mole, ectopic pregnancy, and >35-years old), choriocarcinoma may be the possible diagnosis or at least the main differential diagnosis.