Diagnosis of blunt rupture of the right hemidiaphragm by technetium scan

Traumatic rupture of the diaphragm, particularly of the right hemidiaphragm, may be occult and can be difficult to diagnose if laparotomy is not required for concomitant injury. Missed or delayed diagnosis of such injuries can produce life-threatening complications, such as intestinal herniation, ischemia, and necrosis. We present a case of traumatic rupture of the right hemidiaphragm that demonstrates the typically occult nature of this injury. The majority of right-sided injuries are diagnosed during laparotomy performed for other injuries. In those patients not requiring laparotomy, the diagnosis is usually delayed because this injury seldom produces clinical or radiographic findings that are either sensitive or specific. In this case, intraperitoneal injection of technetium sulfur colloid was used to establish the diagnosis of right diaphragm rupture, and an uncomplicated repair was undertaken.