Abstract: Objective To improve the understanding of primary pulmonary carcinoma accompanying empyema in clinicians. Methods Three cases of primary pulmonary carcinoma accompanying empyema were reported with its related literature reviewed and its etiology,clinical features,diagnosis and treatment summarized. Results The male and female ratio was 5 : 1.Of the 12 patients,10 were diagnosed with squamous cell carcinoma which was classified as central lung cancer at the T2N1M0/IIB phase according to the TNM.Empyema occurred in 4 cases after chemotherapy and in 8 cases before chemotherapy.The pathogenic microorganism of empyema was Streptococcus.Of the 12 patients who underwent closed thoracic drainage and systemic antimicrobial treatment,6 received surgery and 5 survived less than 2 years. Conclusion It is difficult to treat primary pulmonary carcinoma accompanying empyema and its prognosis is poor.Surgery contributes to its prognosis when infection is controlled.