Introduction Blunt trauma leads to large radial tears that lead to immediate herniation Penetrating trauma leads to small tears that take years to herniate More common on left side Presentation Symptoms/physical exam varied Differential CXR shows elevated diaphagm, acute gastic dilation, a loculated pneumohemothrorax insert NG tube and repeat CXR Upper GI contrast series if diagnosis is not clear Peritoneal fluid in in chest tube drainage is diagnositic Treatment/Management Surgical repair