RUPTURES of the diaphragm from blunt trauma to the abdomen or chest are unusual, but not rare injuries and are increasing in frequency. Highway accidents still head the list of causative factors, but rupture of the diaphragm may occur whenever there is a significant blow to the trunk or a sudden increase in intra-abdominal pressure transmitted toward the thorax. Ninety-five percent of diaphragmatic ruptures occur on the left side, apparently because the right hemidiaphragm is more protected by the liver. On rare occasions, both may be ruptured.
The characteristic signs of diaphragmatic injury, namely, severe pain and disturbances of the mechanics of respiration, were described as early as 1579 by Ambroise Paré. Diagnosis of the acute injury is often delayed, as signs of diaphragmatic trauma are often overshadowed by those of visceral laceration or rupture, head injury, or compound injury of the extremities. Particular attention to the mechanics of