Rationale:Primary pulmonary meningiomas are extremely rare, and only a few cases have been reported in the medical literature. Imaging findings of primary pulmonary meningiomas have been reported even more rarely. Patient concerns:We present the case of a 54-year-old male patient with cough and sputum lasting for 20 years. This was a case of primary pulmonary meningioma with initial suspicion of a chest wall intercostal neurinoma. Diagnoses:A lung lesion was detected on chest computed tomography (CT) imaging 4 years ago. This case appeared as a solitary well-defined round nodule close to the left chest wall, with heterogeneous enhancement on CT, which inaccurately led to the suspicion of a chest wall intercostal neurinoma. Interventions:A thoracoscopic wedge resection was performed. Outcomes:The postoperative histological diagnosis was primary pulmonary meningioma. After 2 years of follow-up, the patient is still alive without evidence of metastasis or recurrence. Lessons:Increased awareness of the CT characteristics of this rare tumor may broaden the radiologist's knowledge base.