A 70-year-old man sustained blunt trauma from rollover of a cultivator. Chest radiography showed irregular contour in the left lateral border of the heart (Fig. 1). Chest computed tomography (CT) revealed a markedly dilated pericardiophrenic vein passed along the lateral border of the heart, anastomosing to the left inferior phrenic vein and draining to the left brachiocephalic vein (Fig. 2). He had unknowingly liver cirrhosis, recognized by CT, with a Child-Pugh score of 8 (class B) caused by chronic Budd-Chiari syndrome (Fig. 3). This varicose vein may be usually due to the obstruction of the hepatic venous outflow [1]. Consequently, he had multiple fractures of left ribs with scanty pneumothorax and left renal rupture from trauma, followed by angiographic renal artery embolization. The engorged pericardiophrenic collateral pathway is a rare presentation from liver cirrhosis or Budd-Chiari syndrome [1-3], and direct traumatic injury to it probably could lead to the life-threatening massive hemothorax.

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