Trauma to the chest can result in cardiac damage, which may be missed by clinical examination because of associated injuries. Routinely performed non-invasive tests may also be non-diagnostic. Tc-99m pyrophosphate (PPi) tomography, in this study combined with Tl-201, is a promising addition to non-invasive evaluation. In three patients with cardiac injury, this technique successfully detected and localized myocardial necrosis.