TDI: traumatic diaphragmatic injury; ATLS: advanced trauma life support; CT: computed tomography; MRI: magnetic resonance imaging. * Consider MRI in pregnant patients. ¶ Same signs as suspicion for TDI above. Δ There are cases of isolated TDI with subtle presentation. Laparoscopy is appropriate in a hemodynamically stable patient with an equivocal CT scan and appropriate mechanism for TDI. ◊ When TDI occurs more centrally, repair may be needed in the first look phase to effectively exclude the abdominal compartment from the thoracic compartment and prevent herniation. § Typical left-sided posterior diaphragmatic injuries. ¥ The need to place mesh in the setting of associated organ injury should prompt careful evaluation to rule out bowel injury and ensure control of all other injuries. A second look should be considered.