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Background Respiratory failure caused by metastatic pulmonary chodocarcinoma usually develops rapidly and is associated with a high mortality.The clinical management strategy is important in choriocarcinoma patients with acute respiratory failure.The objective of this study was to evaluate the clinical characteristics,treatment outcome and potential risk factors in patients with acute respiratory failure from metastatic pulmonary choriocarcinoma.Methods Sixteen patients with acute respiratory failure from pulmonary metastases choriocarcinoma were enrolled and treated at Peking Union Medical College Hospital from 1995 to 2010.Clinical characteristics,causes of pulmonary failure,treatment profiles and outcomes were analyzed retrospectively.Results The presence of respiratory infection or hemorrhage was associated with acute respiratory failure in patients with metastatic choriocarcinoma.Fifteen (93.8％) patients presented with pulmonary infection,8 (50.0％) patients with pulmonary hemorrhage.All patients were treated with face mask or mechanical ventilation.Fourteen (87.5％) patients received initial chemotherapy at a low dosage or with modified regimens,with a median of 2 cycles (range 1 to 4).Seven patients achieved a complete remission (CR),two had a partial remission.Six CR patients remained alive with a median follow-up of 59 months (range 16 to 120).Seven patients developed progressive diseases and subsequently died.Conclusions Respiratory infection and hemorrhage were associated with acute respiratory failure in metastatic pulmonary choriocarcinoma.The initial administration of gentle chemotherapy regimens,accompanied with mechanical ventilation,is feasible andeffective in attenuating respiratory failure in patients with metastatic pulmonary chodocarcinoma.