Fluoroscopy-guided percutaneous catheter drainage (PCD) was used in 38 patients to diagnose and/or treat pleural effusions (21), hemothorax (one), symptomatic malignant effusions (four), and empyemas (12). Fluoroscopic guidance combined with the use of a small needle, J-tip guide wire, and pigtail catheter made it possible to safely drain both free and loculated fluid collections, including areas with difficult access. In 11 of the 12 patients with empyema, the pus (or purulent fluid) was successfully drained using PCD. Two or more catheters were used in all but one patient. In four of the empyemas, PCD was used successfully after incomplete or unsuccessful chest tube drainage. In five, PCD was used as the sole means of drainage. In three patients, chest-tube drainage was used to drain residual (one) or recurrent (two) empyemas after PCD. The safety and relative ease of PCD makes it an attractive alternative method for closed drainage of pleural fluid collections.