Malignant pleural effusion is a difficult clinical problem in palliative care. The most common cause of exudative pleural effusion among patients older than 50 years of age are neoplasms. The majority of malignant pleural effusions accompany lung cancer, breast cancer and malignant lymphomas. Dyspnea is the most frequent presenting symptom of pleural effusion and affects considerably the quality of life. Treatment options are determined by several factors: symptoms and performance status, stage of the disease and prognosis. Asymptomatic patients usually do not necessitate immediate intervention. Thoracentesis enables a rapid symptom control. However, repeated therapeutic pleural aspiration is recommended only in patients with poor performance status and adverse prognosis. Intercostal tube drainage followed by chemical pleurodesis is the most common procedure. Essential requirements for successful pleurodesis include maximal fluid evacuation and complete lung re-expansion. Talc is the most effective and safe sclerosing agent. This agent may however occasionally induce an acute respiratory failure (ARDS - adult respiratory distress syndrome). A few cases of ARDS were reported after administration of a high dose (over 10 g) of talk. Doxycycline and bleomycin are others sclerosing agents effective in pleurodesis. Insertion of a long term indwelling pleural catheter drainage is an alternative method for controlling recurrent and symptomatic malignant effusion. Pleuroperitoneal shunting is an acceptable palliative option in patients with trapped lung or failed pleurodesis. Although open pleurectomy is the most effective method of achieving pleurodesis, it is accompanied by a high morbidity and mortality and is rarely performed.