BACKGROUND: There are various causes of exudative Pleural effusion, rather than assumption of a diagnosis by clinical suspicion, proper diagnosis is needed in guiding specific targeted treatment. Exudative pleural effusions necessitate thorough investigation and specialized diagnostic methods. The main objective of this study is to determine the aetiologies of exudative pleural effusion, and to assess clinical profile along with radiological and microbiological profiling in current scenario in Western Maharashtra. MATERIALS AND METHODS: A prospective, observational and cross-sectional study was done on 114 patients of exudative pleural effusion in a tertiary care centre. Patients above 10 years of age with biochemical evidence of exudative effusion were only included in the study. Biochemical, cytological and microbiological tests were done on their pleural fluid and their clinical profile was noted. In selected cases, Patients underwent pleural biopsy, Video Bronchoscopy and Image guided Lung Biopsy. RESULTS: In young population, females were more affected (57%) whereas in middle age and in elderly population, males were more affected. Dyspnoea was the most common symptom. Radiological profiling showed majority had moderate effusion and preferably right sided effusion and >50% effusion were loculated. 70.2 % were of tubercular aetiology, 14 % were of malignant effusion, 10.5 % were of Para pneumonic effusion and 5.3 % were effusion secondary to pancreatitis. Estimation of pleural fluid adenosine deaminase plays an important role in the diagnosis of tubercular effusion. Fluid cytology and closed pleural biopsy helped in diagnosis of malignant effusion.