Massive left diaphragmatic separation and rupture due to coughing during an asthma exacerbation

We report a case of herniation of abdominal contents into the left hemithor ax in a patient hospitalized with an acute exacerbation of asthma accompani ed by paroxysms of coughing. There was no history of trauma. We believe thi s is the first reported case of diaphragmatic rupture complicating an asthm a exacerbation. We review clinical features, pathophysiology, diagnosis, an d treatment of diaphragmatic rupture in its most common setting, trauma, an d discuss its occasional "spontaneous" occurrence.