Pathologic conditions of the pediatric chest are protean. They tend to be either very symptomatic or readily visible to parents and care providers. For these reasons, pediatric surgeons are often asked to assess children with these dramatic lesions. A detailed discussion of all pediatric thoracic conditions requiring surgical treatment is beyond the scope of this article. Instead, the author focuses on those lesions that are common and encountered by primary care pediatricians and family practitioners with some regularity, and severe lesions that require early recognition and treatment. Separating the diseases of the chest into anatomic regions is helpful in understanding their symptoms and treatment. It is also a valuable way to guide the evaluation and differential diagnosis of children with thoracic symptoms.