Evolving technology provides new diagnostic and emergency management options for the surgeon caring for patients with thoracic trauma. Abdominal ultrasound performed by surgeons in the emergency department makes pericardiocentesis and subxyphoid pericardiotomy obsolete. Transesophageal echocardiography supplements aortography in the diagnosis of thoracic aortic injury. New terminologies replace the overused term myocardial contusion. Pulmonary tractotomy is an innovative approach to through-and-through pulmonary penetrating injuries. Centrifugal pumps add new options to thoracic great-vessel injury management. Endovascular stented grafts will be added to the armentarium of the thoracic surgeon for injured vessels.