Background: The present study was conducted to determine 120 cases of pleural effusion underwent medical thoracoscopy. Materials & Methods: 120 patients who underwent medical thoracoscopy in 79 Males and 41 females were recruited. Diagnostic pleural aspiration was done and the pleural fluid was analyzed for sugar, protein, Lactate dehydrogenase (LDH), Adenosine deaminase (ADA), gram-stain, Acid-fast bacilli (AFB) smear, culture, CBNAAT, and cytological analysis. Patients with unhelpful results of pleural fluid analysis (Light’s criteria) underwent medical thoracoscopy and pleural biopsy. Results: 98 (81.7%) had pleural effusion on (CE-CT) thorax as 6 (5%) had mass lesion on left side where 6 (5%) had lesion on right side, 10 (8.3%) had other findings like passive collapse, consolidation, atelectasis, mediastinal lymphadenopathy. 13 (10.8%) patients had edematous mucosa on FOB, 19 (15.85%) patients had external compression on FOB, whereas 77 (64.2%) had the normal study on bronchoscopy, whereas 11 (9.2%) had other findings like anthracotic patches. 38 (31.7%) had inflammation, sago grain like nodules, adhesions on thoracoscopy, 25 (20.8%) had inflammation and adhesions, 51 (42.5%) had inflammation with nodules/masses/plaques, 2 (1.7%) had necrotic/ulcerative/other lesions on thoracoscopy. Conclusion: Medical diagnostic thoracoscopy should be considered in all patients having undiagnosed pleural effusion and fit for medical thoracoscopy