Direct-impact injuries are generally considered less dangerous, resulting, more often, in minor injuries, such as rubbings, ecchymosis, and/or hematomas that sometimes do not even require any imaging evaluation. In some cases, however, direct-impact injuries resulting from a motor vehicle accident, fall, or a direct blow from a moving object can lead to localized wall injuries, such as fractures of the skull, ribs, and sternum and sternoclavicular joint dislocation. Depending on the high kinetic energy, direct-impact forces may be transmitted through the body to the deeper tissues and organs, such as the brain, lungs, heart, liver, and spleen along the trajectory of the “force vector.” In these cases, for example, a direct blow to the chest wall may cause significant vascular injuries requiring immediate treatment, even in the absence of skeleton fractures. Therefore, according to the energy delivered by the injury, a direct impact may evolve into a compression mechanism, as internal organs may be secondarily involved by compression/shearing forces. An example of direct injury is extra-axial brain hematoma (epidural, subdural, and subarachnoid/intraventricular) and intra-axial injury (cortical contusion, intracerebral hematoma) (Figs. 2.9 and 2.10). In blunt brain injuries, cortical contusion may occur when the brain is pushed against the irregular inner surfaces of the skull at the time of impact at the coup site or, more commonly, at the opposite site. This last is produced by the impact of the moving brain to a fixed point, and it is more dangerous when the blow occurs to the occiput, due to the irregular surfaces of the anterior and central skull base, with characteristic hemorrhagic contusions seen in the inferior frontal and temporal lobes (Fig. 2.9) [20]. In the acute setting, a direct trauma to the skull, especially in elderly patients, requires a non-contrast CT scan, which represents the modality of choice, as it promptly allows depiction of intracranial traumatic lesions.