Background: Impaling injuries to the chest are relatively rare and often lethal. Initial evaluation, resuscitation, and surgical planning can be challenging for emergency physicians and surgeons. Chest trauma can be classified as either closed or penetrating, depending on whether or not the pleural cavity is open. Penetrating objects entering chest cavity frequently make an entrance and exit and are often accompanied by visceral/vascular damage. Open thoracotomy or video-assisted thoracic surgery (VATS) are considered the first-line approaches for severe penetrating chest trauma.