Deceleration and crushing injuries of the chest may traumatize the thoracic aorta or its branches. Traumatic aortic rupture has received significant attention over the past 40 years, whereas the aortic arch branch injuries remain under-recognized. Despite the development of new imaging modalities, angiography remains the gold standard for evaluation of a patient with suspected thoracic arterial injury. Recently, computed tomography and transesophageal echocardiography have been used for serial examination of minimal aortic injuries that are treated conservatively. Medical treatment of the ruptured aorta, delayed surgical repair, and endoluminal deployment of stent-grafts are new developments that provide new options and pose new questions in the management of thoracic arterial injuries.