Pitfalls in diagnosis of diaphragmatic tear

Traumatic diaphragmatic injury is a life threatening and an occult clinical entity which can be easily missed in diagnosis. Diaphragmatic ruptures are usually associated with abdominal trauma however, it can occur in isolation. Their delayed presentation can be due to the delayed rupture of the diaphragm or delayed detection of diaphragmatic rupture, making the accurate diagnosis of Diaphragmatic Injury is challenging to the surgeons. Here we report a case of young adult male with poly trauma, whose initial diagnosis revealed multiple rib fractures on right side and right haemothorax and normal left pneumothorax. After intercostal drainage was placed on right side, left diaphragmatic tear with bowel contents in left lung cavity was revealed. He was successfully managed surgically. Hence we report this case to emphasize that a high clinical index of suspicion is needed to diagnose, effectively manage diaphragmatic rupture even with a remote history of high-velocity injury.