<b>Transfixant Injuries of the Mediastinum Always a Challenge</b> Transfixant injuries of the mediastinum are those in which the aggressor object travels through the midline of the thorax, where the mediastinum is located, being associated with high morbidity and mortality. This review of the literature addressed several aspects of the theme, including diagnosis and treatment. A search was carried out in Pubmed, Scopus and Scielo databases, using indexed descriptors and selection of articles by peers. Mortality rates from 20 to 87 among the victims of this injury modality were observed, varying due to the proportion of unstable patients. In patients undergoing thoracotomy resuscitation, mortality rates between 85 100 . The treatment consisted of maintaining the patient s hemodynamic status, so that patients with imminent death in the emergency service should undergo resuscitation thoracotomy, unstable patients should undergo emergency thoracotomy After a brief clinical diagnostic evaluation, while stable patients benefit from further investigation and in up to 60 of the cases, do not require a surgical approach. It was concluded, therefore, that such lesions are associated with high morbidity and mortality, and their approach differs according to the patient s hemodynamic profile in the emergency room. Emergency services should be prepared to meet this new patient profile, which arrives at prompt care with severe injuries and increasingly critical clinical conditions. thorax, penetrating wounds, injury, mediastinum, thoracotomy, hospital service emergencies 93-100 Issue-5 Volume-3 Wysterlânyo Kayo Pereira Barros | Isadora Priscila De Oliveira Sizenando | Tâmara Azevedo De Medeiros | Thomas Di Nardi Medeiros | Wagner Gomes Da Nóbrega Silva | Amália Cinthia Meneses Rêgo | Irami Araújo-Filho