title: Traumatic rupture of the right hemidiaphragm: case report of an unusual means of diagnosis.
abstract: It has been reported that 10 to 20% of all traumatic diaphragmatic ruptures are missed on initial evaluation, only to be discovered at a later date (1). In the chronic state an abnormal chest X-ray, symptomatic visceral incarceration, or barium contrast studies often lead to the correct diagnosis. This is a case of chronic diaphragmatic injury secondary to trauma being discovered when a diagnostic thoracentesis yielded viscous bile. With the needle left in situ a dye study was performed which demonstrated not only a normal cholangiogram, but also a chronic diaphragmatic rupture with partial herniation of the liver. We feel that this case represents a very unusual presentation of an uncommon injury.
mesh_terms: D000063:Accidents, Traffic; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012421:Rupture; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*