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The aim of this study was to provide a case series detailing the occurrence of significant and life-threatening injuries outside isolated orthopedic or head injuries sustained by athletes treated at our institution.This study is a retrospective case series utilizing the trauma registry at a Level I pediatric trauma center. Inclusion criteria included an abdominal solid organ injury Grade III or higher, a major thoracic injury, or an injury resulting in death.Although there have been great strides in research related to prevention and management of concussions sustained by athletes, there is little formal reporting of the incidence or potential complications of the intrathoracic and intra-abdominal injuries. The four cases described represent a compilation of the most significant competitive sports-related injuries managed at a Level I pediatric trauma center during 2012–2013. The case series shows how competitive sports can lead to injuries that require hospitalization with extensive monitoring and interventions, which may predispose the athlete to further complications and, in the rare case, death. Also significant is that these injuries are not solely limited to high contact sports like football but can be seen in a sport like baseball, which may not be as commonly regarded among parents and coaches as posing a risk for serious contact-related injuries.