The traumatic rupture of the thoracic aorta is a severe and lifethreatening entity. It is therefore important to diagnose this lesion. Classically, this is based on the detection of a widened superior mediastinum on chest X-ray. However, several factors like supine position, obesity, mediastinal haematoma,... might bias the diagnosis. The authors present four different clinical presentations of traumatic rupture of the thoracic aorta and describe how the lesion was detected. Subsequently, they review the literature on the diagnostic approach of this severe lesion.