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Gestational choriocarcinoma with inferior vena cava (IVC) tumor thrombus formation is exceedingly rare. We report a case initially presenting with recurrent nausea and vomiting in a 52-year-old woman. Laboratory studies revealed elevated serum β-hCG levels, and ultrasonography demonstrated a pelvic mass extending from the parametrial area into the IVC. Pathological examination of a pelvic mass biopsy confirmed the diagnosis of choriocarcinoma. Further assessment identified pulmonary hypertension and emboli within small pulmonary artery branches. The patient received EMA-CO chemotherapy and achieved complete remission, with no evidence of recurrence during a one-year follow-up. This case highlights the diagnostic challenges posed by non-classical metastases and underscores the importance of considering choriocarcinoma in the differential diagnosis of women with a pregnancy history and unexplained systemic symptoms.