Diaphragmatic injuries are particularly difficult to diagnose. A plain film of the chest demonstrating viscera in the chest or a nasogastric tube coiled in the thorax will definitively diagnose a diaphragm injury. More often, chest x-ray findings are far more subtle or completely absent. Diagnostic peritoneal lavage (DPL) can be helpful, particularly if the DPL fluid exits via a concomitantly placed chest tube or if follow-up chest x-ray demonstrates a new pleural effusion. Helical CT and magnetic resonance imaging (MRI) can both be helpful in determining the presence or absence of a diaphragmatic injury. 4 Occasionally, blind surgical exploration or a less invasive technique such as laparoscopy or thoracoscopy may be necessary to make the diagnosis of diaphragmatic injury.
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