Shot Through the Heart—Firepower and Potential Lethality of Air Weapons

Although certain air weapons attain muzzle velocities comparable to some firearms, their successful use for committing suicide is rarely seen. Herein, we report a case of a young female died shortly after urgent admission to the hospital with penetrating gunshot wound to the chest. The autopsy revealed perforation of the pericardium and two perforative defects to the right heart ventricle. Injury was inflicted by a 0.177 caliber pellet, fired from an air rifle found near her body. Investigation ruled the death as suicide. The used air rifle fired the pellet with the energy density of 1.9 J/mm², substantially above the threshold for inflicting injury. The pellet penetrated through two layers of cotton fabric and several layers of tissue to inflict fatal injury to the heart. In addition, we provide an insight into the wounding potential of air weapons, which illustrates the need for greater caution in handling those devices.     

Automatic rifle injuries: suicide by eight bullets. Report of an unusual case and a literature review

A 25-year-old man committed suicide by shooting himself with eight bullets fired from a military rifle set on automatic. This rifle has two firing modes: an automatic mode and a self-loading, single-shot mode. Using this case as an example, some important aspects of firearm injuries are discussed with special emphasis on those points that are relevant to automatic military rifles and most applicable to forensic pathology practice. Some of the pathologic features of firearm wounds are reviewed and the role of the pathologist is discussed. Lastly, the most important points that help the pathologist to determine the type or nature of a firearm death--that is, whether it is an accident, homicide, or a suicide--are discussed. Classically, the number of the firearm wounds is used to differentiate suicide from homicide. As in the case reported here, however, when an automatic rifle or a military rifle set on automatic is used, the number of wounds is not a reliable indicator of the type of death.     

Suicides by starter's pistols and air guns

We report the case of a 25-year-old depressed woman who committed suicide with a starter's pistol loaded with CS tear-gas ammunition. The propellant gases of the contact shot entered her chest through the left sixth intercostal space. Exsanguination was caused by perforations of the pericardium and apex of the heart. Autopsy did not reveal any metallic or other foreign bodies that might have originated from the propellant, the cartridge, or any bulletlike material. Her injuries were thus caused by the propellant alone. 0.5 mg L-1 of the CS degradation product cyanide was detected in the cardiac blood. We also report the case of a 54-year-old man, suffering from depressive psychosis, who committed suicide with an air rifle. The lead-pointed Diabolo bullet entered his brain through the right large wing of the sphenoid bone, traversed the right temporal brain pole, damaged the right middle cerebral artery and the right optic tract, and finally lodged in the left central ganglia. There was extensive basal subdural hemorrhage and tamponade of all cerebral ventricles. Death was attributed to cerebral failure. We furthermore list another 26 cases of suicide by rarely used weapons from 1947 to 1989.     

Suicidal Shotgun Wound Employing a Shotgun Barrel,a Shotgun Shell,and a BB*

Abstract: A vast majority of firearms‐related suicides involve the conventional use of a properly functioning, intact firearm. Occasionally, forensic investigators encounter a case wherein the firearm suicide victim employs some form of unconventional use of a weapon, or utilizes an unusual weapon type. In this case report, the authors present an unusual case in which a man committed suicide by using a shotgun shell, a shotgun barrel (separate from the rest of the gun), and a BB. Some confusion as to the cause and manner of death was present during the initial scene investigation. Examination at autopsy revealed the cause of death to be a shotgun wound of the chest and prompted further scene investigation. Therefore, this case serves as another example of the importance of cooperation between scene investigators and forensic pathologists when investigating a death. A review of suicidal firearm cases using unconventional means and/or firearms is presented.     

Gunshot suicide with nasal entry

A man with a long history of depression had recently borrowed a rifle. His body was found on its back in bed in his caravan. A rifle lay over the body with the muzzle pointing towards the head. A suicide note was found at the scene. Autopsy revealed entry via the nose with the track passing through the base of the skull to the right parietal region where the main bullet fragments were located beneath the scalp. The history, scene and autopsy findings were consistent with the gunshot wound being suicidal. We can find only one mention of a suicidal gunshot wound with nasal entry in the English-language literature, although a personal communication informed us of a similar case in the Republic of Ireland within the past two years. We report this case because of its unusual nature.     

Pellet embolization to the right atrium following double shotgun injury

A 28-year-old man sustained two shotgun injuries of the left inguinal region from a distance of about 1.5 m by simultaneous discharge of both shells from a sawn-off double-barrelled 16-bore shotgun (diameter of the lead pellets, 4 mm). The first X-ray examination carried out soon after hospital admission showed a single embolized pellet near the right margin of the cardiac silhouette. Eight months later, the man committed suicide by drug intoxication. At autopsy, the embolized pellet was found embedded between the pectinate muscles of the right atrium. On the basis of the reported case and with reference to the pertinent literature, the paper points out the medico-legal aspects of venous bullet/pellet embolism and the risk of lead poisoning after shotgun injury.     

A distant-range, suicidal shotgun wound of the back

The case being reported is one of a shotgun fatality with a thoracic back wound. A 23-year-old man was shot from a distance with trajectories going from back to front and on a nearly horizontal level. These findings observed in the autopsy could represent homicide, but scene investigation and police records were interpreted and it became clear that the case was suicide. Thus, this case shows that the determination of the manner of death requires a careful forensic investigation including autopsy findings, scene investigation, and reconstruction of the events.     

Rifle wounds: a review of range and location as pertaining to manner of death

Given the prevalence of rimfire and centerfire rifle usage in both suicidal and homicidal cases, there is a paucity of articles in the literature that focus specifically on rifle wounds. Gunshot wounds, in general, have been extensively studied with articles focusing on the types of injuries, weapons used, wound locations and weapon range. We designed a study to examine the characteristics of rifle wounds, including both centerfire and rimfire rifles, especially pertaining to location and range of the wound. All deaths due to rifles examined at the Bexar County Medical Examiner's Office between 1988 and 2004 were reviewed. A total of 509 cases were identified, with 233 suicides and 266 homicides. We found that the average age of suicide victims (41.6 years) tended to be older than that of homicide victims (32.6 years). Suicides tended to be contact wounds to the head whereas homicides most often had multiple wound locations sustained from a distant range. The most common location to the head of suicidal wounds was intraoral whereas homicidal head wounds were more often to the temporoparietal region. We developed odds ratios for assessing the manner of death given a wound location or range; however, we caution that every case should be analyzed based upon it's unique circumstances and not solely its statistical probability.     

Symmetrical fracturing of the skull from midline contact gunshot wounds: reconstruction of individual death histories from skeletonized human remains

This paper reports a bilaterally symmetrical cranio-facial fracture pattern that is observed in self-inflicted, midline gunshot wounds. Five cases of self-inflicted gunshots wounds are presented as follows: two high-powered rifle cases, two shotgun cases, and one handgun case. In all five cases the remains were either decomposing or skeletonized and submitted to forensic anthropologists. Following identification, the main focus of the anthropological examination was the analysis of perimortem trauma to the skeleton. In each case, the skull was submitted in a highly fragmented state. Nevertheless, by focusing on the pattern of perimortem cranio-facial fractures, the anthropologists contributed key information regarding the circumstances of death. The observed symmetrical cranio-facial fracture patterns in the above cases are described in detail and interpreted. The specific location of the linear fractures is discussed, as well as the theoretical rationale behind the location in terms of skeletal architecture, such as buttresses, struts, and sutures. The interpretive framework provided by this paper may prove helpful to others who are faced with similar cases of cranio-facial fracturing.     

Suicidal gunshot to the nape from a small-bore rifle

A 55-year-old man was found dead on the bed lying on his side in a pool of blood with a bullet entrance hole in the nape. Behind his body, a semi-automatic rifle Remington Nylon, cal. .22 LR, was detected. As the gunshot entrance site was rather unusual for suicide, a forensic autopsy was performed, which showed a contact shot to the nape with the bullet path running upward to the left frontal area. The man had been treated with citalopram for delusional depression, so that a suicidal act seemed plausible, and the autopsy and criminalistic findings were also compatible with this assumption. A remarkable fact of the present case is that a long firearm had been used. Reports on suicidal shots to the nape are comparatively rare in the medicolegal literature and usually refer to pistols or revolvers.     

Firearm suicide committed using an unusual combination of tandem missiles: a bullet, a nail, and a screw

An interesting case of firearm suicide carried out using an unusual type of handmade weapon and a peculiar combination of tandem missiles is presented. A nail and a screw were placed in the rifle barrel ahead of a bullet, and all 3 were simultaneously discharged. The inflicted injury began with 1 common channel, which later split in 2 separate channels, both directed backwards and upwards; one was caused by the screw, ending in the epistropheal body, and the other, caused by the bullet and the nail, penetrated into the cranial cavity, where it bifurcated in 2 branches, one from the bullet, ending in the cerebellar tissue, and the other from the nail, penetrated through the brain stem. The established site of the entrance suicidal wound, the appearance of the weapon, and the unusual missiles are discussed with regard to the available references dealing with different types of nail injuries to the head.     

Hair combing to collect organic gunshot residues (OGSR)

A protocol is presented for the collection and analysis of gunshot residues (GSR) from hair. A fine-toothed comb is used for collection of the residues. A small zip-closure bag serves as a container for both sample storage and extraction of the characteristic organic powder additives. The success of this residue recovery approach was tested on simulated shooters and victims using mannequin-supported human wig hair as well as on human shooters. Residues were collected from four weapons: a revolver and semi-automatic pistol, rifle and shotgun. One characteristic additive, nitroglycerin, was detected by capillary electrophoresis (CE) in the majority of the collection experiments.     

Shotgun wounds: a review of range and location as pertaining to manner of death

Shotguns are used in a considerable number of homicides and suicides, and while gunshot wounds are extensively reported in the literature, there is a paucity of shotgun deaths. To specifically study deaths by shotguns, all deaths due to shotguns examined at the Bexar County Medical Examiner's Office between 1988 and 2005 were reviewed. The cases were evaluated by age and sex of the victim, wound location, wound range, and manner of death. Three hundred eighty-seven cases were evaluated, composed of 343 males and 44 females, with 180 homicides, 203 suicides, 3 accidents, and 1 undetermined manner of death. Contact wounds were the most common range in suicides and the head was the most common location. For homicides, the most common range of fire was distant, and the most prevalent distributions of wounds were head, chest, and multiple wound locations. Statistical analysis showed significant differences between homicide and suicide wound locations and ranges, and then odds ratios were generated. Knowledge of the statistical distribution of shotgun wounds in a large series with respect to range of fire and wound location may be of assistance to the medical examiner in evaluating the circumstances of an individual case to arrive at a manner-of-death opinion.     

Multiple suicidal gunshots to the head

We report two cases of suicide by multiple gunshots to the head. The first victim (of two shots) fired the first shot, which was observed, into his mouth, leading to damage to the left optic nerve and frontal lobe. The man still was able to drive his car home, where he shot himself in his right temple. He died 2 days later. The second victim (of three shots) was a 58-year-old man who was found dead on his bed. Reconstruction of the case disclosed that the first shot had passed through his tongue and slightly damaged the second cervical vertebral body. He then shot himself in his right temple, leading to damage of the temporal lobe. Finally, he shot himself in his left temple, resulting in destruction of the pons. In the first case, an amateurishly modified 8-mm blank revolver firing 6.35-mm- (.25)-caliber ammunition was used; in the second case, a rifle firing 5.6-mm (.22)-caliber ammunition with a reduced charge was used. In both cases, low-energy transfer to brain tissue by the initial bullets was due to low bullet energy or due to the bullets' missing the brain or vital centers.     

Case report of suicide by inhalation of nitrogen gas

Nitrogen is an inert gas that is a normal constituent of the air that we breathe. It is a suffocating gas that does not support life and that can be a cause of death by the displacement of oxygen in the atmosphere. The majority of deaths associated with nitrogen have occurred in the setting of scuba diving. Although other suffocating gases have been used as a means of committing suicide, the literature contains little information about the use of nitrogen as a suicidal agent. A case of a 50-year-old man who committed suicide using a homemade suicide device and nitrogen gas is presented.     

An apple a day does not always keep the doctor away...

The authors describe a case of suicide in the workplace. A 45-year-old man employed by a fruit and vegetable packing company was found dead in a room containing a modified atmosphere for the packaging of fruits and vegetables. The rescue team measured the carbon monoxide (CO) concentration of the ambient air with a digital CO tester and found a level higher than 600 particles per million. Analysis of an arterial blood sample taken with an airtight syringe revealed the absence of CO but high levels of carbon dioxide (CO(2)). Autopsy revealed no significant injury and police investigators found a handwritten note of intent, describing a recent personal crisis. The authors concluded that the cause of death was suicide by asphyxiation secondary to CO(2) intoxication and notably oxygen (O(2)) depletion. This manner of suicide is rare and most cases previously described in the literature were accidental intoxications. To the best of our knowledge, this is the first case of suicide by CO(2) intoxication and O(2) depletion in a room with a modified atmosphere.     

Fatal hunting injuries in North Rhine-Westphalia

The investigation covers 14 fatal hunting accidents which occurred in North Rhine-Westphalia in the last 23 years, among them 13 firearm fatalities. All the accidents happened during the statutory hunting season reaching a peak in the main small game season. 86% of the persons causing the accidents and 73% of the victims were over 41 years and experienced hunters. 36% of the accidents were caused by the victims themselves. The fatal gunshot injuries were inflicted by rifle bullets in 7 cases (54%) and shotgun pellets in six cases (46%). No accidents were due to shotgun slugs or handgun ammunition. The main factors responsible for the fatalities were: covering the victim while swinging on the game (31%), failure to discharge the firearm while descending from the raised hide or transporting the weapon in vehicles (31%), mistaking the victim for game (15%), failure to discharge the weapon during a hunting break or while pressing down obstacles or careless handling of the weapon (23%). In no case was the accident caused by a defective weapon or ammunition. In conclusion aspects of preventing fatal hunting accidents are discussed.     

Entrance, exit, and reentrance of one shot with a shotgun

The case being reported is one of a homicidal shotgun fatality with an unusual wound pattern. A 34-year-old man was shot at close range with a 12-gauge shotgun armed with No. 5 birdshot ammunition. The shot entered the left axillary region, exited through the left infraclavicular region, and thereafter penetrated the left side of the neck, causing tearing of the left common carotid artery and the right internal carotid artery. The entrance wound in the axilla was larger than the other wounds, and before autopsy it was believed that the shotgun had been fired twice, causing one wound in the neck and one wound perforating the infraclavicular region and exiting through the left axillary region. Thus, this case shows that unusual wound patterns in shotgun fatalities can easily lead to incorrect assumptions with regard to number and direction of shots fired unless thorough investigation is carried out postmortem.     

Suicide by Shotgun in Southeastern Minnesota

Suicide by shotgun is a common method of suicide with high regional variation. We sought to describe their distinct, challenging features and provide demographic and risk characteristics. We reviewed 228 gunshot wounds autopsied at Mayo Clinic from 1994 to 2014; of these, 75 (32.9%) were shotgun wounds. All were suicides and contact range. Ages ranged from 14 to 92 years old; of these, 97% were men. The majority involved the head (70.9%), were intraoral (48.2%), and had upward (73.2%) and backward (73.2%) directionality. Next most common was the chest (21.5%), with backward (94.1%) and downward (64.7%) directionality. Four involved multiple wounds. Wadding was recovered in 16 (21.3%) cases. Six (8.0%) had a survival period. Most (66.7%) took place at home. Seventy‐one percent had a known psychiatric history; 32.4% had positive toxicology. Although contact range shotgun wounds cause severe destruction, entrance wound and other characteristic are identifiable with thorough scene, autopsy, and radiographic documentation.     

Single wound produced by simultaneous discharge of both shells from a double-barrel shotgun

We present the case of a man who was killed by simultaneous discharge of both barrels of a double-barrel shotgun. Externally, there was a single wound simulating a wound made by a discharge of a single barrel. Test-firing of the shotgun against cloth, paper, and naugahyde targets revealed defects similar in shape to the wound in the victim. Simultaneous discharge of both barrels from a double-barrel shotgun may simulate the wound made by discharge of a single barrel.