We defined injuries to the heart and the pericardium together with hemopericardium as pericardial tamponade type injury regardless of symptoms or signs due to pericardial tamponade. The aim of the study is to examine the important factors related to the diagnosis and treatment of this type of injury. A retrospective chart review was conducted of traumatized patients admitted with hemopericardium to our institution between 1978 and 1995. Ten out of the 19 consecutive patients with pericardial tamponade type injury demonstrated shock and showed a higher Injury Severity Score and mortality (7/11) than the remaining 9 without shock. The majority of our cases received an emergency room thoracotomy or a surgical fenestration and thereafter some of them needed a (re-)thoracotomy in the operating room. We consider a fenestration through the pericardium to be the first choice for the relief of acute hemopericardium due to trauma, while surgeons should not perform pericardiocentesis for the either diagnosis or relief of this type of injury.