The medical records of 21 patients with primary echinococcosis in the pleural cavity that received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from January 2000 to April 2025 were retrospectively collected, and a descriptive epidemiological method was employed to analyze the demographic features, epidemiological characteristics, clinical manifestations, chest CT scans, treatment and outcomes. The case series included 14 men and 7 women and had a mean age of 44.8 years. There were 11 cases with a history of staying in epidemic areas or contact with canines. There were 15 cases with echinococcosis in the right-side pleural cavity, 14 cases identified using physical examinations, 15 cases with multiple hydatid cysts, and 19 cases with a medical history of hepatic echinococcosis. Surgical interventions consisted of thoracoscopic surgery among 6 cases and thoracotomy among 16 cases. Postoperative complications included pulmonary infection (8 cases), pneumothorax (2 cases), and empyema (1 case), and conventional postoperative pathological examinations revealed cystic echinococcosis in 16 cases and alveolar echinococcosis in 5 cases. Of all cases, there were 4 cases lost to the 36-month follow-up after discharge from hospital, and among the 17 cases completing follow-up, there were 2 cases with recurrence 12 and 15 months post-surgery and 15 cases without recurrence. These findings demonstrate that preoperative chest CT scan is the optimal choice for evaluation of parasitic diseases primarily originating from the pleural cavity, and thoracoscopic resection may represent a feasible and safe therapeutic strategy for selected patients following thorough professional assessment.