Aim and background: Pericardial rupture with cardiac herniation following blunt trauma is an exceedingly rare and often fatal condition, typically resulting from high-energy deceleration forces. With an occurrence rate of 0.37% in blunt trauma cases and a mortality rate of 36.4–42.9%, prompt diagnosis and surgical management pose significant challenges (Fulda et al., 1990; Sohn et al., 2005; Guenther et al., 2020). This case report documents a novel use of cardiac-gated computed tomography (CT) to assist in the rapid diagnosis of this condition. Case description: A 30-year-old woman presented to a local hospital following an eight-story fall with multiple injuries. After treating initial life-threatening conditions, X-ray imaging showed a mediastinal shift and an abnormal cardiac silhouette. The patient was transferred to a Level I trauma center for further management. Shortly after arrival, an electrocardiogram (ECG)-gated cardiac CT scan revealed a blunt traumatic pericardial rupture (BTPR) with atrial herniation. After addressing other life-threatening injuries, a sternotomy and pericardial exploration were performed, revealing a large tear on the right side of the pericardium with right atrial displacement. The pericardial defect was large and, therefore, not repaired as it was deemed to be low risk for strangulation. Conclusion: Blunt traumatic pericardial rupture with cardiac herniation is a rare and potentially fatal condition that requires a high index of suspicion and prompt management. Advanced imaging techniques, such as ECG-gated cardiac CT angiography and transesophageal echocardiography, play a crucial role in diagnosis and surgical planning. Treatment should prioritize life-threatening injuries and consider the size and location of the pericardial rupture. Clinical significance: This case highlights the importance of increased awareness and vigilance among healthcare providers when managing patients with severe blunt chest trauma. Increased awareness of this rare injury pattern among providers and the utilization of advanced imaging modalities can lead to timely diagnosis and appropriate surgical intervention, ultimately improving patient survival in cases of BTPR with cardiac herniation.