Aim The present study discussed cases of pulmonary hydatid cysts with pleural complications presenting with pneumothorax and empyema, which were retrospectively reviewed in terms of diagnostic and therapeutic procedures and for which the authors' clinical experience was presented. Material and Method: A total of 23 cases of pulmonary hydatid cysts with pleural complications that were treated at our clinic between 2007 and 2014 were retrospectively reviewed. The pleural complications in these patients included pneumothorax (34.78%), pyothorax (17.39%), pyopneumothorax (26.08%), hydropneumothorax (21.75%), and severe pleural thickening (17.39%). Results: At the initial step, 19 patients (82.61%) underwent tube thoracostomy and drainage, and 4 cases (17.39%) underwent thoracentesis. The cystotomy and capitonnage were the most commonly performed procedures in open surgery (89.95%). The prolonged air leakage was the most common (30.43%) postoperative complication, and cases that developed massive air leakage and broncho-pleural fistula were re-operated, and of these cases, three (10.5%) underwent lobectomy and one patient (4.34%) underwent segmentectomy. None of the cases in our series developed mortality. Discussion: A clinical picture involving empyema, pneumothorax, or both will constitute a diagnostic conundrum for hydatid cyst. Early recognition of the hydatid cysts will prevent the development of complications and reduce postoperative morbidity and mortality.