The diagnostic value of roentgenology in 85 patients who had to undergo surgery because of diaphragmatic rupture at the university of Freiburg from 1973 to 1985 is reviewed. The ratio of left- to right-sided diaphragmatic rupture is 62 to 23. Preoperatively the following diagnostic procedures were used: chest film examination in 82, plain film of the abdomen in 64, contrast radiographs of the gastrointestinal tract in 21, ultrasonography in 37, computed tomography in 8 and angiography in 9 patients. Sensitivity and specificity of these diagnostic methods depend on an intrathoracic prolapse of abdominal structures and on the existence of concomitant injuries. The combination of all these procedures improved the diagnostic accuracy. In 11 patients a diaphragmatic rupture was only detected by surgery.