Computed tomography (CT) is the imaging modality of choice in the asse
ssment of patients with clinical or radiographic findings suggestive o
f aortic injury, bone fracture, or diaphragmatic tear following blunt
chest trauma. Contrast material-enhanced spiral CT allows detection of
both subtle and more obvious aortic tears. CT has overall greater sen
sitivity than radiography in the detection of pulmonary lacerations an
d pneumothoraces, CT may be indicated in cases of suspected tracheobro
nchial injury. CT is of limited use in the assessment of rib fractures
because such injuries are of limited clinical significance and can us
ually be identified at radiography; however, CT provides optimal visua
lization of thoracic spine fractures and superior assessment of suspec
ted sternal fractures or sternoclavicular dislocation. Targeted spiral
CT with sagittal and coronal reformatted images has increased sensiti
vity and specificity over that provided by conventional axial CT in th
e detection of diaphragmatic injury. Optimal CT assessment requires ca
reful attention to technique, including the use of intravenously admin
istered contrast material and multiplanar reconstructed images, as wel
l as an awareness of potential pitfalls, Although in many cases diagno
sis can be made with confidence on the basis of CT findings, further i
nvestigation is often needed to confirm the diagnosis.