10% of chest traumata are accompanied by injuries to the mediastinal organs. Since rupture of a bronchus may be masked by additional intrathoracic injuries any suspicion of such lesion must be verified by bronchoscopy. Symptoms of a shock condition after traumatization of the precordial region point to damage to the heart the extent of which may range from a slight disturbance of cardiac function (commotio cordis) to laceration of cardiac tissue and rupture of the myocardium. Enlargement of the mediastinum after a sufficiently forceful chest trauma should be examined by visualization of the aortic arch to elucidate its aetiology and exclude an aortic aneurysm. The mortality of chest trauma involving the mediastinal structures is 35%. This fairly high figure is partly attributable to severe accompanying injuries.