Imaging plays an important role in the evaluation of pleural disease. This review discusses the advantages and disadvantages of various imaging techniques utilized in the evaluation of pleural disease and highlights the imaging appearance of some commonly encountered pleural pathologies. The role of image-guided interventions in the pleura is reviewed. A variety of imaging techniques can be used to evaluate pleural pathologies. Chest radiography is the most readily available tool for investigation and routine follow-up. Other modalities such as ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography play a unique role in further characterizing the abnormality identified on chest radiographs or to solve a particular clinical question. In this review the imaging appearance of common pleural pathologies and the potential advantages of the above-mentioned imaging techniques are discussed.