Pleural effusion is common in various diseases and especially malignant effusions can have rapid onset symptoms such as dyspnea, chest pain, and coughing. The diagnosis and the treatment approaches require several pleural techniques and knowledge about concomitant disease. In exudative effusions accompanying inflammatory reactions in pneumonia are the most common reasons. Malignant effusions are typically seen in lung and breast cancer patients. The differential diagnosis has to always include malignant pleural mesothelioma. The therapeutic approach is dependent on staging, symptoms, and prognosis of the underlying diseases. Techniques should include thoracocentesis, various chest drainages including indwelling permanent catheters and talc pleurodesis done by slurry instillation or by surgical approaches. This review addresses diagnosis options and treatment modalities including thoracocentesis, thoracoscopy, chest drainage, and indwelling catheters. Clear algorithms are presented.