CT and MRI of a transcardiac gunshot wound with an annular distribution of bullet fragments surrounding an exit-re-entrance wound after the bullet burst from a floor tile upon exiting the lying body

Abstract Context.—Gunshot wounds are the most common cause of homicidal death in the United States. Analysis and interpretation of fatal gunshot wounds is an important and common practice among forensic pathologists. Additionally, for pathology residents, it is an integral aspect of their training during their rotations at medical examiner or coroner offices. Objective.—The correct interpretation of gunshot wounds by forensic pathologists not only provides valuable information that can assist law enforcement in their investigation but also is essential for the final determination of manner of death. Discussion of the practical, basic, and essential skills required to interpret gunshot wounds include distinguishing a classic entrance wound from an exit wound; recognizing atypical entrance and exit wounds; utilizing the features of soot and stippling patterns to differentiate among contact, close, and distant range gunshot wounds; understanding of the trauma produced by gunshot wounds; and understanding the importance of recovering and documenting/handling any projectiles recovered at autopsy. Data Sources.—This article reviews numerous standard forensic pathology textbooks and the pertinent literature to formulate practical guidelines to assist the pathologist in the performance of forensic autopsies and the investigation of gunshot wound fatalities. Conclusions.—Pathologists who perform investigations and autopsies to determine the cause and manner of death in gunshot wound cases must be aware of the implications, requirements, and pitfalls in interpretation of the injuries so that the examination fulfills its expectations to the community and the justice system.

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Non-powder Lateral Penetrating Craniocerebral Gunshot Wound in a 10-Year-Old Girl: A Case Report

10.21203/rs.3.rs-89254/v1 ◽

2020 ◽

Author(s):

Christopher Lauren ◽

Donny Argie ◽

Elric Brahm Malelak ◽

Reza Mawardy ◽

Samuel Edhi Suranta ◽

...

Keyword(s):

Mortality Rate ◽

Gunshot Wound ◽

Blood Clot ◽

Signs And Symptoms ◽

Gunshot Wounds ◽

Low Velocity ◽

Gun Barrel ◽

Entrance Wound ◽

Air Gun ◽

The Right

Abstract Background: Non-powder lateral penetrating craniocerebral gunshot wounds (PCGW) is one of the lethal types of penetrating head injury. The mortality rate is higher in adults than in pediatric populations and influence by the clinical and radiologic findings as the important predictors for prognostication in patients with PGCW. Case Presentation: A 10-year-old girl presented with a gunshot wound to the head 1 day prior. She was accidentally shot by her brother with an air gun from approximately 2 feet from the gun barrel. She develops a loss of consciousness for 30 minutes and weakness over the left arm. In physical examination, the patient Glasgow Coma Scale (GCS) was E3 V5 M6, weakness on the left arm, and an entrance wound over the right temple without an exit wound. The skull X-ray show the pellet fragment and the computed tomography (CT) scan show the bullet track starting from the right frontotemporal towards the left parietooccipital region, damaging both hemispheres with associated intraventricular hemorrhage (IVH). She undergoes a craniotomy procedure to remove the bullet fragment, debridement of the necrotic tissue, and evacuating the blood clot the formed over the bullet track. The patient discharge after postoperative day 7 with good recovery of neurological function and good GCS and Glasgow Outcome Scale (GOS) score. After 6 months follow-up, neither a new deficit nor other signs and symptoms were developed.Conclusions: Non-powder PCGW can cause significant damage to the intracranial compartment, despite its low velocity. The mortality rate in pediatrics is lower than in adults population. The management mandated an urgent surgical procedure to remove any blood clot and debridement of any foreign bodies encountered. Such complications in short- or long term can be developed in any patients and should be treated expectantly.

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Transmediastinal and Transcardiac Gunshot Wound with Hemodynamic Stability

Case Reports in Surgery ◽

10.1155/2014/985097 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Leire Zarain Obrador ◽

Yusef Mohamed Al-Lal ◽

Jorge de Tomás Palacios ◽

Iñaki Amunategui Prats ◽

Fernando Turégano Fuentes

Keyword(s):

Gunshot Wound ◽

Median Sternotomy ◽

Uneventful Recovery ◽

Hemodynamic Stability ◽

Group Iii ◽

Entrance Wound ◽

Group I ◽

Breath Sounds ◽

Chest X Ray ◽

The Right

Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW) and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500 cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed. Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP>100 mmHg; group II, with SBP 60–100 mmHg; and group III, with SBP<60 mmHg. The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.

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