<![CDATA[Pleural effusion reflects either systemic disease or local pleural pathology. Treating the effusion as a final diagnosis can delay recognition of infection or malignancy. To present a cause-specific diagnostic and management framework for adult pleural effusion. This narrative review selected 30 journal articles published from December 2023 through March 2026, identified through PubMed and journal or publisher websites up to September 15, 2026. Records were checked against DOI metadata; neither meta-analysis nor formal risk-of-bias assessment was undertaken. Initial evaluation combines clinical assessment, thoracic ultrasound and a decision on diagnostic thoracentesis. Paired pleural-fluid and serum studies, fluid pH and glucose, cultures, cytology and focused investigations guide subsequent management. Pleural infection calls for antibiotics and drainage when indicated; symptomatic malignant effusion requires an individualized choice of pleurodesis or an indwelling catheter, whereas systemic transudates require treatment of their underlying disease. A staged, cause-directed approach supports timely drainage of high-risk effusions and avoids unnecessary procedures.]]>
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