Traumatic diaphragmatic rupture involving the pericardium

We have described a case of severe blunt injury to the thorax and abdomen causing an 8 cm laceration of the central tendon of the diaphragm, with extension into the pericardium. Herniation of the apex of the heart through this defect produced hypotension that was unresponsive to fluid resuscitation. Replacement of the heart into the mediastinum promptly restored the blood pressure to satisfactory levels.