Background: The accurate diagnosis of pleural effusion remains a challenging clinical problem. Medical thoracoscopy has an established role in achieving the etiology of pleural effusion. Pleural biopsies provide us with best results, but if cytological results can be shown to give concordant results, therapy can be instituted early. Aim: The aim was to study the efficacy of pleural brush in diagnosing pleural diseases. Study Design: This is a prospective study. Patients and Methods: The study was done between December 2015 and June 2017 in all patients of undiagnosed exudative effusions who were taken for thoracoscopy. Both pleural biopsy and pleural brushings were obtained in each patient. Results: We present the data of 45 patients. The mean age was 59.68 years. Nodule was the most common finding on thoracoscopic examination. Pleural brush cytology was positive in 26 patients with malignancy, 13 for infection and 6 were inadequate. However, forceps biopsy was positive in 42 cases out of 45 (93.3%) in detecting malignancy and infectious diseases. Conclusion: Pleural brush cytology can help in increasing the diagnostic yield. It can also be used to commence early treatment of the patient.