This case emphasizes that diaphragmatic rupture can be extremely subtle on the initial CT imaging, and can take several days, weeks or months to present itself in trauma patients. Interestingly, left hemidiaphragm is more commonly involved than the right hemidiaphragm, likely due to the buffering effect of the liver.

It is therefore important to consider delayed diaphragmatic rupture on follow up x-rays for trauma patients, if there is evidence of an elevated or unclear hemidiaphragm border or intrathoracic herniation of a hollow viscus.