Ruptured diaphragm as a result of blunt trauma can present acutely or late in the disease, process. Late presentation is often a result of herniation of abdominal contents into the thorax. Patients may present with nonspecific symptoms, and may complain of chest pain, abdominal pain, dyspnea, tachypnea, or cough. Clinicians must have a high index of suspicion for prompt diagnosis. Diagnostic tools include chest radiograph, CT scan, and MRI. The treatment for rupture of the diaphragm is surgical. The authors report a case of traumatic rupture of the diaphragm presenting 20 years after an automobile accident with blunt trauma to the abdomen.