Thoracentesis and tube thoracostomy are important procedures utilized for the diagnosis and treatment of pleural effusion, empyema, pneumothoracies, and systemic diseases. In this chapter, procedural technique, utility of ultrasound (U/S) for procedure performance, the principles of manometry, procedural complications, evidence behind the need for post-procedural chest X-ray, and the utility of ultrasound in subpleural mass biopsies are discussed.