The ultimate goal for the management of malignant pleural effusion (MPE) is to relieve dyspnea and avoid multiple procedures that would interfere with a patient’s quality of life. Therapeutic options include the use of oxygen and morphine for patients with an extremely limited life expectancy, repeat thoracentesis, placement of a tunneled pleural catheter (TPC), and pleurodesis. Because nearly 100% of MPEs will recur within 1 month, repeat thoracentesis often is used for patients with an expected survival < 4 weeks. It stands to reason that the least invasive methods that will provide long-term relief should be used for patients expected to survive > 1 month. Not surprisingly, a small-bore TPC is recommended by British Thoracic Society guidelines1 for the management of MPE.