White lung: the effects of trauma

Diaphragmatic rupture occurs in 0.8-5% of patients with major blunt thoraco-abdominal trauma and up to 70% of diaphragmatic tears are missed initially. Elevation of a single hemi diaphragm can be attributed to adjacent pleural, pulmonary or subphrenic disease, or it can occur secondary to a phrenic nerve palsy. (1) Rarely, it is related to an intrinsic weakness of the diaphragm or eventration. Because diaphragmatic rupture is often associated with thoracic or abdominal injuries that require surgical treatment, the diagnosis is usually made intraoperatively in many cases. Special attention has to be given to minor changes in the diaphragm or to basal lung atelectasis or consolidation. If possible, the post-injury thorax films should always be compared with previous chest radiographs.