Right-sided diaphragmatic injury: rarity or overlooked diagnosis?

Although more than 90% of diaphragmatic injuries are said to occur on the left side, we have recently managed six patients with right-sided diaphragmatic injuries. In four instances, the diaphragmatic injury was not discovered until laparotomy was undertaken for concomitant visceral injury. All patients who underwent operations had fractures and abdominal visceral injuries as well. This experience, plus the difficulty of establishing a diagnosis of injury to the right hemidiaphragm preoperatively, makes us suspect that the true incidence of right-sided diaphragmatic tears is higher than usually stated. A high diaphragmatic shadow, elevation of the inferior liver edge, and acute changes at the right lung base are among the roentgenographic findings associated with diaphragmatic tears.