A 57-year-old man was directly transported to our emergency department via the emergency medical service. The patient was found lying on the floor after a trauma. The initial chest computed tomography (CT) scan showed a suspicious diaphragm injury (
Fig. 1.) with thoracic aortic injury. The trauma team called an intervention radiologist who performed emergency thoracic endovascular aortic repair for aortic rupture. A follow-up abdominal CT scan for liver injury was performed to obtain more detailed information regarding a suspicious diaphragm injury. The herniated liver dome was more prominent (
Fig. 2.), and we decided on surgical repair of the injured diaphragm. The patient was sent to the operating room and underwent thoracoscopic examination under double-lumen general endotracheal anesthesia. We found traumatic diaphragm injury and herniation of the liver dome (
Fig. 3.). The herniated liver dome was strangulated and had superficial laceration on the surface without active bleeding. We performed a lateral thoracotomy and repaired the injured diaphragm with nonabsorbable sutures in an airtight manner (
Fig. 4.). The right-sided traumatic diaphragm injury was found incidentally through serial coronal views of chest and abdomen CT scans for evaluation of multiple severe injuries. The traumatic diaphragm injury was successfully managed through thoracoscopy and lateral thoracotomy under doublelumen general endotracheal anesthesia. The ruptured diaphragm could be tightly repaired without any complication owing to the early stage of injury.