A 62-year-old man underwent operation for tension pneumopericardium and left hemothorax caused by multiple rib fractures. He sustained other multiple injuries, such as acute subdural hematoma, compound fractures of the left leg. At left thoracotomy, massive hemorrhage from the left apical lung disrupted by the first and second fractured ribs was encountered and pericardium was seen to be bulging and tensely inflated. Incision of the pericardial sac resulted in expulsion of air with a subsequent fall in central venous pressure and heart rate. And after repair of the tear of the laceration of the left lung, the chest was closed with underwater seal drainages of the left pleural cavity. He was successfully weaned off the ventilator after 12 days. After extubation, repeated bronchoscopy was done, but the tracheobronchial injury was not able to be found out.