Malignancy is one of the most common causes of pleural effusion. Malignant pleural effusion is defined by the presence of malignant cells in the pleural fluid. Development of malignant pleural effusion usually defines advanced malignancy. Pathophysiology of malignant pleural effusion is not fully understood and may involve complex interactions between the mesothelial and malignant cells. Investigations and management of patients with malignant pleural effusion require a multidisciplinary approach. In this review, current practice for management of patients with malignant pleural effusion will be discussed. In addition, imaging techniques will be covered, including the use of thoracic ultrasound and its role in image-guiding pleural procedures. Moreover, interventional techniques will be described, such as medical thoracoscopy, the use of indwelling pleural catheters, or surgery for investigation and management of malignant pleural effusion.