Non-penetrating traumatic rupture of the diaphragm

The authors present 3 patients with non-penetrating traumatic rupture of the diaphragm and 1 patient with eventration of the diaphragm which was misdiagnosed as a rupture. Rupture of the diaphragm may follow a blow to the chest or abdomen which initially seems to be of little consequence. There may be few symptoms referable to the rupture immediately after the accident, but severe symptoms may develop subsequently. The diagnosis of a ruptured diaphragm should therefore be considered in patients with multiple injuries even though there is no evidence of a chest or abdominal injury and early routine chest x-ray performed. The radiological difficulties of differentiating a ruptured diaphragm from eventration, phrenic paralysis or non-traumatic herniation through the diaphragm, are discussed. Differentiation is not always possible. Once the diagnosis of traumatic diaphragmatic rupture is made, early repair is indicated.