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A 52-year-old female with past medical history of diabetes mellitus, hypertension and chronic renal disease presented with nonischemic cardiomyopathy and left ventricular failure. On day one, an intra-aortic balloon pump (IABP) and Swan-Ganz catheter were placed uneventfully. The IABP metallic tip was positioned in the proximal descending aorta (Fig. 1). A follow-up chest radiograph obtained the next day demonstrated that the IABP metallic tip was in a stable position (Fig. 2 A). Two days after IABP placement, the patient complained of severe chest pain without significant change in vital signs. The chest radiograph demonstrated interval mediastinal widening (Fig. 2 B). The patient underwent emergent chest computed tomography (CT) without contrast due to compromised renal function. Findings concerning hemomediastinum, left hemothorax and hemopericardium (Fig. 3 A) were noted. Sagittal reconstruction …