The assessment of traumatic lesions to the chest and thoracic spine can pose a challenge for the emergency radiologist. Collaboration with the treating clinicians and knowledge of the patients' history and the trauma mechanism are essential. In case of minor trauma, digital radiography may be sufficient for diagnosis. For the diagnostic work-up of polytrauma patients, multidetector computed tomography (MDCT) is the most important modality due to its broad availability and higher sensitivity. The chest has to be completely contained within the scan volume to be able to adequately analyze the bony structures and thoracic spine. Reconstruction in three planes and multiplanar reconstruction are prerequisite for a correct diagnosis and further therapy planning. Magnetic resonance imaging (MRI) serves as a third level diagnostic modality in special cases. MRI can demonstrate bone marrow edema of vertebral bodies or other bones. In addition, the myelon and the epidural space are best assessed with MRI. In this article, the most relevant knowledge for the diagnostic work-up of traumatic lesions of the bony chest and the thoracic spine is summarized.