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The evaluation of an idiopathic pleural effusion can be difficult. Physicians’ fear of missing a potentially resectable malignancy compels them to continue the evaluation even after a negative thoracentesis and pleural biopsy. It has been suggested that bronchoscopy should be routinely used in these patients to rule out endobronchial malignancies. We reviewed the existing literature to determine the utility of empiric bronchoscopic evaluation in this patient population and provide recommendations on the timing and appropriateness of its use.