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Pericardial rupture in blunt trauma is rarely seen on computed tomography (CT) imaging due to its high initial mortality. We report a case of a 53-year-old man who presented to the Emergency Department in hemodynamic shock after intentional fall from height. Chest radiograph, which was taken in the trauma bay as a part of his primary survey, showed abnormal mediastinum contour with pneumopericardium. Pericardial rupture with cardiac herniation, and tamponade secondary to pneumopericardium, was diagnosed on trauma CT scan. The patient underwent emergent surgical management with thoracotomy to reduce the herniation and repair the pericardium. Immediate suspicion for pericardial and cardiac injury on the initial chest radiograph and rapid diagnosis on CT was indispensable for this patient's favorable outcome. Keywords: Cardiac herniation, Pericardial rupture, Chest trauma, Blunt trauma, Tamponade