Physical examinations are not accurate, as there is usually no specific physical sign that can be used to diagnose this condition. Thoracoscopic and laparoscopic methods can be accurate. Chest X-ray is known to be unreliable in diagnosing<unk> ; it has low sensitivity and specificity for the injury. Often another injury such as pulmonary contusion masks the injury on the X-ray film. Half the time, initial X-rays are normal; in most of those that are not, hemothorax or pneumothorax is present. A nasogastric tube from the stomach may appear on the film in the chest cavity; this sign is pathognomonic for<unk> , but it is rare. The X-ray is better able to detect the injury when taken from the back with the person upright, but this is not usually possible because the person is usually not stable enough; thus it is usually taken from the front with the person lying supine. Positive pressure ventilation helps keep the abdominal organs from herniating into the chest cavity, but this also can prevent the injury from being discovered on an X-ray.Axial lower chest CT scan showing bowel herniation due to left<unk> A CT scan has an increased accuracy of diagnosis over X-ray, but no specific findings on a CT scan exist to establish a diagnosis. The free edge of a<unk> d diaphragm may curl and become perpendicular to the chest wall, a sign known as a dangling diaphragm. A herniated organ may constrict at the location of a<unk> , a sign known as the collar sign. If the liver herniates through a<unk>  on the right side, it may produce two signs known as the hump and band signs. The hump sign is a form of the collar sign on the right. The band sign is a bright line that intersects the liver. it is believed to result due to the<unk> d diaphragm compressing. Although CT scanning increases chances that<unk>  will be diagnosed before surgery, the rate of diagnosis before surgery is still only 31–43.5%. Another diagnostic method is laparotomy, but this misses<unk> s up to 15% of the time. Often<unk>  injury is discovered during a laparotomy that was undertaken because of another abdominal injury. Because laparotomies are more common in those with penetrating trauma than compared to those who experienced a blunt force injury,<unk>  is found more often in these people. Thoracoscopy is more reliable in detecting<unk>  tears than laparotomy and is especially useful when chronic<unk>  hernia is suspected. Location Between 50 and 80% of<unk> s occur on the left side. It is possible that the liver, which is situated in the right upper quadrant of the abdomen, cushions the diaphragm. However, injuries occurring on the left side are also easier to detect in X-ray films. Half of<unk> s that occur on the right side are associated with liver injury. Injuries occurring on the right are associated with a higher rate of death and more numerous and serious accompanying injuries. Bilateral<unk> , which occurs in 1–2% of<unk> s, is associated with a much higher death rate (mortality) than injuries that occur on just one side.
Diaphragmatic rupture
Bochdalek hernia
Flail chest
Hemothorax
Urinothorax
Pulmonary contusion
Hemopneumothorax
Hydropneumothorax