Case: A 64-year-old man was injured after falling from a height of 5 m and was transported to our institution. On presentation, his hemodynamic state was unstable, and both focused assessment with sonography for trauma and enhanced computed tomography imaging revealed massive left pleural effusion, but no pericardial effusion. He went into cardiopulmonary arrest just before surgery, so an urgent left anterolateral thoracotomy followed by open chest cardiac massage and aortic clamping were carried out. By performing an additional right anterior thoracotomy, a left pleuropericardial laceration and a perforation measuring 1 cm in diameter at the left ventricle were found. The patient's dynamic state stabilized following the restoration of hemostasis by suturing the rupture site.
Outcome: The patient's postoperative course was favorable, and he was discharged after 20 days of hospitalization.
Conclusion: Blunt cardiac and pericardial injury rarely causes massive hemothorax with no hemopericardium, resulting in hemorrhagic shock.
Keywords: Blunt cardiac injury; cardiac tamponade; clamshell thoracotomy; hemothorax; pericardial injury.