Benign asbestos pleural effusion (BAPE) is a pleural effusion that occurs following significant asbestos exposure, with the exclusion of other identifiable causes. It typically appears decades after exposure, usually in individuals during the sixth or seventh decade. The effusion is often captured incidentally on imaging, which demonstrates a small to moderate, one-sided pleural effusion; however, larger or bilateral cases have been reported. In addition, the presence of pleural plaques may hint at the diagnosis. The pleural fluid may appear bloody and is often exudative in nature. Pleural fluid analysis is necessary in order to exclude malignancy. No single test confirms BAPE, as diagnosis relies on documented asbestos exposure and exclusion of all other potential causes. Treatment includes monitoring for small, asymptomatic effusions. Drainage of the pleural fluid often results in resolution. This chapter reviews the pathophysiology, diagnosis, and treatment of BAPE.