Delayed presentation of diaphragmatic rupture: an unusual case of dyspnea.

Diaphragmatic injuries are relatively rare, and they are the result of penetrating or blunt trauma. Blunt diaphragmatic rupture occurs mainly from high-speed motor vehicle crashes. Sudden increase in intra-abdominal pressure may cause a diaphragmatic tear and visceral herniation. The magnitude of the pressure load on the inflexible central tendon by rapid deceleration may cause such catastrophic injury. The predicted outcome for these patients is associated with the severity of the disruption. However, diaphragmatic rupture may go unnoticed, and in many cases, diagnosis is delayed. In the delayed phase, symptoms are nonspecific and suggestive of other disorders, such as COPD and partial bowel obstruction. Clinical suspicion and a past history of multi-trauma are very important and useful to avoid diagnostic pitfalls. We present the case of a female patient with dyspnea due to delayed diagnosis of diaphragmatic rupture.