Objective: The aim of this retrospective study was to review pleural and pericardial complications of patients with hydatid cysts and to analyze the management of therapy for these patients. Methods: Between 1991 and 2001, 43 (29.7%) of 145 patients presented with pleural and pericardial complications. These patients had spontaneous pneumothorax (6.2%), empyema (7.6%), pleural thickening (10.3%), hepatopleural fistula (2.8%), pericarditis (2.1%), and hepatobronchial fistula (0.7%). There were 22 male and 21 female patients, with a mean age of 30 years. Results: The most common symptom was chest pain (79.1%). In 37 (86.1%) of 43 patients, the cysts were unilateral. The ratio of ruptured cysts was 88.4%. In most of the patients, hydatid cysts developed in the right lung (62.9%) and the lower lobes of the lung (70.4%). Multiple cysts were found in 8 (18.6%) patients. The most common surgical techniques were cystotomy with capitonnage (55.7%) and decortication (69.8%). Radical lung resection was used in 14% of the patients. The morbidity rate was 16.3%, and the mortality rate was 2.3%. The mean follow-up was 19 months with no recurrence. Conclusions: Although lung-preserving surgical interventions should be preferred, radical surgical procedures have been used more commonly in patients with pleural complications of hydatid cysts, and the postoperative morbidity rate was higher in these patients. Because of this, the surgical treatment should be carried out before the development of pleural complications. In addition, echinococcosis should be considered and included in the differential diagnosis of spontaneous pneumothorax and empyema.