Pleural effusion is the most common presentation of pleural diseases. It is relatively common in children with two predominant types: exudative and transudative effusions. In children, exudative types are the most common with bacterial infection being the most prevalent cause. In some cases, effusion could be difficult to confirm. We describe two patients with a similar age group who presented with respiratory distress in the form of fever, cough, and shortness of breath. They were managed clinically and radiologically as cases of parapneumonic effusion. Both were started on antibiotics with no improvement. After reviewing the cases, it was discovered that some crucial aspects of the history and physical examination that were essential to reach the correct diagnosis had not been taken into consideration. Parapneumonic effusion should be taken with caution, meticulous history and examination are warranted, and lymphocytic-predominant effusion is very alarming for potential malignancy in the absence of tuberculosis infection. If the antibiotic medication yields no significant improvement, earlier referral should be considered.