Occult diaphramatic injury in penetrating trauma:a diagnostic challenge

Diaphragmatic injuries in penetrating trauma are occult and may be easily missed.Common signs of diaphragmatic injury on computed tomography scan include discontinuous and/or dangling diaphragm sign,thickened diaphragm,organ herniation,collar sign,associated rib fracture,and contiguous injury on either side of the diaphragm.The detection of these signs varies based on the mechanism of injury,that is,penetrating versus blunt injury.Surgical management of an unstable patient with penetrating trauma and diaphragmatic injury is exploratory laparotomy,while laparoscopy is an alternate option in hemodynamically stable patients.A high level of suspicion is required to avoid missing this occult diagnosis and its associated complications.