Pleural effusions are frequently encountered in the clinical setting, affect thousands of patients annually, and have numerous etiologies. The interventional radiologist has an important set of tools available for the treatment of pleural effusions, ranging from image-guided chest tube placement to thoracic duct (TD) embolization. Knowledge of these nonvascular percutaneous interventions is an essential part of the basic and advanced toolset for every practicing interventional radiologist. An understanding of the pathophysiology of various pleural pathologies, the appropriate indications for small-caliber tube thoracostomy placement, and the management of chest tubes in the periprocedural setting is vital for appropriate patient care. In this chapter, the etiologies, management protocols, and techniques for treatment of several types of pleural effusions are reviewed, with a special look at the lymphatic system.