Inferior vena cava (IVC) rupture from blunt trauma is rare. It occurs most commonly in the retrohepatic location in association with liver trauma involving the hepatic veins.1,2 Rupture of the IVC has a reported mortality of up to 50% before arrival to the hospital and nearly 57% in patients who reach the hospital with signs of life.2 Traumatic transection of the thoracic aorta occurs more commonly. It remains a highly lethal injury with 85% of patients dying at the injury scene. If left untreated, approximately 50% of survivors die within the first 24 hours and 90% within the first 4 months.3–5 The most common location of thoracic aortic injury is immediately distal to the origin of the left subclavian artery at the attachment of the ligamentum arteriosum. We report an unusual case of a 19-year-old patient who survived combined intrapericardial rupture of the IVC with transection of the mid-thoracic aorta, and a grade-III splenic injury after a motor vehicle crash.