The chest radiography (CXR) remains the most commonly used diagnostic imaging test in patients with both benign and malignant pleural disease for both the initial diagnosis and disease monitoring. The increasing availability and lower cost of portable ultrasound scanners, compared to larger more expensive and less mobile scanners, and their use by thoracic physicians, emergency department and intensive care doctors, and others have seen a rapid increase in the use of ultrasound. This has led to improvements in care with earlier diagnoses of pleural disease and safer interventions. Additionally, there has been a substantial increase in the availability of CT scanners and with their reduced scan times and greater spatial resolution due to improved detector technology, CT is now used with increasing frequency to diagnose and monitor care in patients with pleural disease. PET-CT is now also more readily available, and it has also benefited from technological advances, enabling it to be used in specific circumstances for patients with pleural disease. This chapter describes the use of all imaging modalities, the benefits and limitations, and highlights future areas for research and advancement.