The use of ultrasound in the evaluation of blunt thoraco-abdominal trauma is well described. Evidence for the use of ultrasound in the evaluation of penetrating cardio-thoracic and abdominal trauma, however, is more limited and varied. Current literature demonstrates that ultrasound is an excellent screening tool for penetrating thoracic and cardiac injuries with a high sensitivity for detecting injury requiring acute intervention. For abdominal injuries, however, the sensitivity for detection of injury is low and thus the utility of ultrasound as a screening tool is limited. This review summarizes the existing literature addressing the clinical utility of ultrasound for penetrating trauma to the pericardium, thorax and abdomen.