The structures of the chest wall and thoracic outlet are complex. A working knowledge of their anatomy and of its variations is essential to any thoracic surgeon working in the area. Correlating imaging with anatomy is just as important if one wants to recognize surgical indications, and potential operating difficulties. In the past, conventional radiographic examination was the norm but interpretation was often difficult and incomplete. Currently, CT and MRI are the best available imaging tools, and most times they have complementary roles in the evaluation of chest wall anatomy.