TITLE: The pattern and outcome of surgical pleural effusion at the National Hospital Abuja. STUDY OBJECTIVE: To study the etiological pattern of surgical pleural effusion and outcome of treatment. METHODOLOGY: Between February 2005–February 2006 some cases of surgical pleural effusions were sampled prospectively. Study parameters were clinical symptoms and signs, radiological features, pleural fluid analysis, primary disease condition, treatments and outcome of treatment recorded at one and six months after treatment. EP1- INFO Statistical Software was used and data was presented in form of tables, pie chart and bar charts. RESULTS: Eighty six patients participated. Fifteen declined. Breathlessness and dullness to percussion on the affected hemithorax were found in 100% of cases. Pleural effusion was confirmed on chest radiography. Straw colored fluid was found in 47 cases (54.7%). Malignant pleural effusion was the commonest cause contributing 35 cases (40.7%). Breast carcinoma was the commonest neoplasm implicated in malignant pleural effusion contributing 23 cases (65.7%). Chest drain was the main stay in management of surgical pleural effusions irrespective of the cause. All patients with malignant pleural effusion had pleurodesis while those with chronic empyema thoracis had decortication as an additional procedure. Sixteen cases (84%) of parapneumonic effusions made excellent progress at one month with only three cases progressing to empyema thoracis. Second best outcome was tuberculous effusion while malignant pleural effusion (MPE) had the poorest outcome. SPleurodesis was successful in 62.3% of cases of MPE at one month evaluation, but it did not improve the overall survival in patients with MPE. CONCLUSION: Evaluation and principled application of chest drain, pleurodesis and decortication impacted positively on the early outcome of patients with pleural effusion.