A review of 1,007 patients treated a spinal injuries unit revealed 11 instances of rupture of the diaphragm. In five patients it took more than 48 hours before the ruptured diaphragm was diagnosed. The hazards of delay in diagnosis and treatment were highlighted by three instances of gastric perforation--two due to attempted pleural aspiration and one spontaneous. There is a need for the greater use of contrast radiology in the assessment of these patients.