Extraction of a bullet floating in the pulmonary artery after a gunshot wound

Background Patients with thoracic trauma caused by gunshots face a high risk of death, and medical staff often encounter technical difficulties in resolving these cases. Most gunshot wounds result in an entrance and exit wound. In cases with no exit wound, missiles are seen in other areas with screening radiographs. The bullet may migrate depending on gravity, coughing, swallowing, blood flow, or local erosion. Case presentation We present the case of a teenager who was hospitalized in critical condition owing to a left hemithorax injury caused by an improvised explosive device. The patient underwent two surgeries: an anterior left thoracotomy during which a hole in the myocardium was sutured, and after radiography, anterolateral right thoracotomy was performed, in which a deformed projectile was found at the level of the intermediate right pulmonary artery. Conclusions This case highlights the crucial importance of repeated imaging to assess the possibility of projectile migration within the cardiovascular system in similar cases of penetrating injury. Immediate surgery was necessary and very important for the survival of our patient, despite the difficulties presented by this complicated case.

Viability of Bos taurus scapulae as a flat bone proxy for ballistic testing

BackgroundHandguns and rifles are often involved in violent deaths such as homicide and suicide. Consequently, forensic investigations are important to clarify the nature of ballistic trauma.MethodsThis study investigated the differences in entrance and exit wound morphology with Bos taurus (bovine) scapulae that have two cortical layers surrounding a central cancellous bone section which are comparable with human flat bones, with a series of experiments using six different calibres (0.22 Long Rifle, 9×19 mm North Atlantic Treaty Organization, 0.40 Smith & Wesson, 0.45 Automatic Colt Pistol, 5.56×45 mm and 7.62×51 mm). B. taurus (bovine) scapulae were used for closed range 30 cm simulated executions.ResultsThe ballistic experiments presented similarities in entrance wound morphology and exit wound bevelling with that of recognised forensic cases. As muzzle velocity increased, bevelling increased. Circumferential delamination is clearly visible with full metal jacket rounds, yielding similar bone damage morphology as human crania.ConclusionBovine scapulae seem appropriate for ballistic simulations of flat bone injuries on the macroscopic level, if the correct portion of the scapulae is deployed. More research is needed to further substantiate these interpretations.

A fatal near-range gunshot below the chin in a child

A 14-year-old child was shot from distance in a neighboring country. The all available data was taken from the father without any idea about the scene investigation or the witness statements. On external examination, we have found a near-range gunshot entry wound with an ovalshaped entrance defect in the submental region. The defect edges were crenellated and scalloped showing the appearance of a "rat-hole" surrounded by concentric soot area with deposited burned grains and enfumage zone (Image 1). A reentry wound surrounded by a red-purple zone in the tongue underside (Image 2) and an exit wound in its upper side were found. At the frontal region, a stellate exit wound was seat of brain matter and bone splinter (Image 3). X-ray showed bone fractures without any metal object (Image 4). At autopsy, the tongue was shredded and there was a massive hemorrhage in the aero digestive crossroads. The external beveling of the exit wound was associated with skull bursting, sub- and extra-dural hematomas, and multiple brain hemorrhagic foci. Lack of ballistic study, we only confirmed that "penetrating cranio-facial trauma with at least one near-range gunshot below the chin" was the cause of death. Thus, all hypotheses of accident, suicide or homicide were possible provided the shot was fired from short distance. After confronting the father to this finding, he confessed that he tried to conceal the truth in order to protect his older son. The deceased was shot by his 16-year-old brother, while they were playing "cops and robbers" game.

Carboxyhemoglobin Detection in the Periorificial Tissues as an Accurate Method for Identifying the Gunshot Entrance Wound

One of the main objectives of the forensic expertise in gunshot injuries is establishing the direction of the shooting. The first step of the process is represented by studying the macroscopic differences in the morphology of the entrance and exit wounds, which in most cases suffice for the differential diagnosis between entrance and exit wound. In some cases, making the difference by using morphology alone is not possible, because the two wounds may present common or peculiar features. In these cases, analytical investigations can help in solving this important aspect of the case investigation. The detection of carboxyhemoglobin (COHb) in the perilesional tissues is one of the differentiation criteria between entry and exit wound. In some cases of short range shooting included in our study group, we determined the COHb concentration in blood sampled from the entrance wound. COHb values ranged between 10% and 60%. Given the known chemical stability of COHb, its determination can also prove useful in the examination of putrefied bodies, where the morphology of the gunshot wounds is more or less altered, depending on the stage of putrefaction.