Patients with lung cancer may present with more than one primary lesion arising in the lung at the same time and then be classified as having synchronous multiple primary lung cancer (MPLC). We described an 80-year-old man who presented with a chronic cough and respiratory distress. A roentgenogram of the chest showed the presence of a tumor at the right upper lobe (RUL) and right lower lobe (RLL), accompanied by left pneumothorax. The findings on a computed tomography of the chest showed a tracheal tumor and tumors at the RUL and RLL. Histological examination was carried out, and revealed that the tracheal tumor and the RUL tumor were squamous cell carcinoma, while the RLL tumor was small cell carcinoma.