Trauma is one of the most sudden, dramatic and often irreversible medical conditions. Injury to the chest is, in turn, one of the most important aspects of trauma, directly accounting for 25% of all trauma related deaths and playing a major contributing role in another 25% of trauma deaths. These figures are all the more tragic when one considers that most trauma is related to motor vehicle accidents which often involve otherwise healthy young adults. This review is not intended to be an all encompassing synopsis of trauma imaging, but rather a down and dirty overview of those injuries which most impact the patient well being. First it must be said that radiographs play no role in the initial evaluation of a critically injured patient. The basic ABCs of cardiopulmonary resuscitation always take precedence. If a patient is having difficulty breathing and a pneumothorax is suspected, a chest tube should be placed; this is both diagnostic and therapeutic. A chest film only delays the therapy. Once a patent airway, adequate ventilation and systemic circulation are established, than imaging may proceed. Once a patient is stabilized, chest imaging is indicated in almost every trauma patient. Those injuries which are most threatening should be identified promptly. Tension pneumothorax, aortic rupture, misplaced lines and tubes, cardiac tamponade from hemopericardium, spine and rib injury, simple pneumothorax, and hemothorax must all be identified if present. If these cannot be adequately evaluated on a routine chest film, this should be noted to the ER physician and other studies, (e.g. CT, angiography, MRI) should be suggested.