Pneumopericardium and pneumomediastinum following closed chest injury are rare findings, especially when symptoms are delayed for several days and are not associated with other related traumatic entities. A case is presented of a 14-year-old boy who developed symptoms of precordial chest pains and splinting two days after sustaining a direct blow to his anterior chest wall. A work-up confirmed free air in the pericardium and mediastinum. He recovered rapidly after a three-day hospital course. The diagnosis was relatively simple, using only thorough physical examination and radiographic technique. This complication should be considered in the differential diagnosis of sudden onset of cardiorespiratory conditions following trauma.