Disruption of the diaphragm by blunt trauma: new dimensions of diagnosis.

Early diagnosis of diaphragmatic defects after blunt trauma is difficult. Multiple co-existing injuries complicate the accurate detection of lacerations of the diaphragm. Roentgenographic evaluation and a "high index of suspicion" have proven to be inefficient and inaccurate, since the average reported time for diagnosis is three and one-half years. Modified peritoneal lavage with intercostal water seal tubes in the pleural spaces is an added dimension of diagnosis. Earlier detection of diaphragmatic defects should become possible by this method.