Cardiothoracic emergencies are a major source of morbidity and mortality in the elderly population. An understanding of these conditions is especially important given that there is an increasing geriatric population. Additionally, the clinical presentation of diseases in the elderly can differ from younger patients. Elderly patients may be more likely to present with nonspecific symptoms, making imaging particularly vital in making the correct diagnosis. Treatment decisions may also be complicated by comorbid conditions more common among geriatric patients, including comorbidities that increase surgical risk. This chapter focuses on important traumatic and nontraumatic emergent conditions organized by compartment in the chest, ranging from chest wall to cardiac and mediastinal pathologies. Common conditions include pneumonia, pulmonary edema, hemothorax, heart failure, and myocardial infarction. Other important acute cardiothoracic diseases to be discussed include esophageal injuries such as perforation and acute vascular conditions such as aortic dissections and mycotic aneurysms. An understanding of the presentation, imaging findings, and management of these conditions is paramount for radiologists taking care of this important cohort.