Management of hemothoraces related to trauma follows basic tenets well respected by both trauma and cardiothoracic surgeons. In most instances, a nonoperative approach is adequate with a defined group of patients requiring only tube thoracostomy. It is only in a true minority of individuals that operative intervention necessary. For both blunt and penetrating injuries, the presence of retained hemothorax is well treated by early intervention with thoracoscopic techniques, shown to decrease hospital stay and costs. Controversial areas including the use of prophylactic antibiotics, sequence of operative intervention in patients with combined thoracoabdominal trauma, and the use of emergency department thoracotomy, remain a challenge but recent literature can serve to guide the clinician.