Introduction: This is a review of gunshot wounds to the chest. Although uncommon in Norway, they represent a big health problem in other parts of the world and in war situations. Method: A systematic literature search using PubMed and McMaster+. Results: Gunshot wounds to the chest can be highly lethal. Depending on the injured organ, a large percentage of the patients die before reaching the hospital. There is a big difference between low-velocity and high-velocity weapons. Low velocity injuries are most common in the civilian sector, whereas high-velocity injuries are over-represented in war zones and cause much greater tissue damage. The initial evaluation at the hospital needs to be quick and well practiced in order to rush the most critical patients to treatment and surgery without delay. All organs in the thoracic cavity may potentially be harmed. Parenchymal lung injury is the most common and the usual form of presentation is hemo- or pneumohemothorax. The most common forms of presentation of cardiac injury are cardiac tamponade and excessive hemorrhage. However, most patients with gunshot wounds to the chest can be managed non-operatively, or with a simple chest drain. Conclusion: Gunshot wounds to the chest are dangerous injuries. In order to decrease mortality, good systems for transportation and experienced personnel are necessary.