A 22-year-old man fell 12.2 m (40 ft), injuring the right lower lobe bronchus, right inferior pulmonary vein, and left atrium. These injuries were not associated with fractures, cardiac tamponade, or pneumothorax. The severity of injury became apparent only upon right thoracotomy for persistent hemorrhage. This case presented special diagnostic and surgical challenges and suggests a role for the increased use of bronchoscopy in major blunt chest trauma.