Pleural fluid collections are common medical issues, occurring frequently secondary to pneumonia, surgery, infection, and sometimes neoplasm. Therapeutic options include thoracentesis, antibiotics, surgical chest tube, or IR catheter drainage and surgery (video-thoracospopic or open decortications). Placing an image-guided percutaneous chest catheter is an attractive alternative to surgically placed chest tubes because of the advantage of precise placement under image guidance and small caliber of the catheter (5–14 F versus approximately 24 F for chest tubes). Pleural effuisions resulting primarily from underlying cardiac, liver, or renal conditions are most commonly treated medically and rarely require drainage.