Trauma is the leading cause of death in people less than 40 years of age. Blunt and penetrating chest trauma mechanisms and the resultant injuries and complications are reviewed in respect to the chest wall, pleura, lungs, mediastinum, and diaphragm. Recent literature reviewed includes a useful sign of flail chest, the costal "hook sign." New evidence suggests that traumatic aortic rupture may be more common in the pediatric population than was previously reported. The diagnostic evaluation of traumatic aortic rupture continues to be controversial, with imaging modalities ranging from chest radiographs and angiography to CT, MR imaging, and transesophageal echocardiography. Recent integration of these methods has brought to the literature a newly proposed algorithm for the work-up of suspected aortic rupture. Survival and modifying factors in adult respiratory distress syndrome and a comprehensive review of esophageal disease, including trauma, are also presented.