We report two patients with pancreatic pleural effusion who presented with dyspnea. Patient 1 was a male in his 40s and patient 2 was a male in his 60s. Both have the same past history of chronic alcohol-related pancreatitis. The chest X-ray and CT images showed massive pleural effusion and a pancreatic pseudocyst extending to the posterior mediastinum through the esophageal hiatus. The thoracentesis fluid was bloody, black in color, and sterile. Amylase in pleural fluid was elevated to a high level. From these examinations, in both cases a diagnosis of chronic alcohol-related pancreatitis accompanied by mediastinal pancreatic pseudocyst and pancreatic pleural effusion was made. Patient 1 was treated by thoracic cavity drainage, endoscopic nasopancreatic drainage, and somatostatin analogue. Patient 2 underwent only thoracic cavity drainage. In both cases, the pleural fluid with a high amylase level disappeared, and pancreatic pseudocyst was reduced with such treatments. Pancreatic pseudocyst was considered as one of the differential diagnoses of pleural effusion, especially with black pleural fluid.