Late presentation of traumatic rupture of the right hemidiaphragm

A 30-year-old male Caucasian was involved in a road traffic accident, where he sustained a severe right chest injury. There was a 15 cm long laceration on the anterolateral part of the right chest below the nipple, which involved chest wall muscles but the intercostal muscles were intact. A chest radiograph revealed fractures of the posterior right eighth, ninth and tenth ribs, with associated haemopneumothorax for which an intercostal drain was inserted. Repeat chest radiograph revealed an elevated right hemidiaphragm. There were no associated abdominal injuries. The chest laceration was repaired under general anaesthesia, and the patient was later discharged. He presented again 21 weeks later with persistent right chest discomfort, and a chest radiograph showed persistence of the right diaphragmatic elevation (Figure 1). A computed tomography scan of the chest and abdomen suggested a possible traumatic rupture of the right hemidiaphragm. A right thoracotomy through the sixth intercostal space was perfor...