Blunt injury of the pericardium are uncommon. Most injuries like this are discovered on autopsy. We received a 45 year old male involved in a motorcycle versus fixed object accident. He was intubated for low GCS. He was found to have extensive subcutaneous emphysema and decreased breath sounds on the right side. A right tube thoracostomy initially drained 200cc of blood. His FAST was indeterminate and his GCS was 6. After primary survey, we proceeded with a whole-body CT scan. The most significant findings on CT were the extensive bilateral pneumothoraces. For our initial management, we performed a left tube thoracostomy which drained 100cc of blood. His ECG showed diffuse ST elevation in non-contiguous leads and in a new chest x-ray, we noted that were a shifted mediastinum and significant cardiac displacement into the left thorax, suggesting the patient had cardiac herniation. A thoracoscopy was indicated and we found a complete cardiac herniation. We noted that the phrenic nerve was preserved. We reduced the heart into the pericardium and the pericardium was easily reapproximated and closed with a running suture. He returned at ICU. On post-operative day 5, a repeat CXR showed recurrent cardiac herniation. We brought the patient back to the operating room. We started the procedure by thoracoscopy and noted that the heart was enlarged, and the pericardium was retracted. We had to convert to an open thoracotomy and repaired the pericardial defect with a porcine graft. Unfortunately, the patient died 5 hours after this repeat procedure.