Case Report of a Migrating Bullet: An Unusual Cause of Postmortem Confusion

Migrating bullets are rare sequelae of penetrating gunshot wounds. Such cases have been described in the neurosurgical literature because they can produce complications in the management of patients such as decline in neurologic status, delays in rehabilitation, and difficulties in bullet removal. In contrast, few postmortem reports have described this phenomenon. We report a case of a gunshot wound in which the projectile entered the left side of the head and traversed to the right frontal area as documented by CT scan on hospital admission. At autopsy, the bullet was noted to have migrated back to the left side of the head from where it was recovered. Medical examiners need to be aware of this unusual phenomenon of retained intracranial projectiles.     

The effects of certain intermediary target materials and their proximity to ballistic gelatin on jacketed hollow point bullet expansion

Expanding bullets are preferred by law enforcement because of their wounding potential and ability to avoid over-penetration which could result in unintended targets being struck by bullets that perforate their intended targets. Expansion failure for jacketed hollow point (JHP) bullets is commonly attributed to several causes including damage to the bullet's cavity, velocity loss, bullet destabilization and materials from intermediate targets filling the bullet's cavity which can cause expansion failure when the bullet subsequently impacts a soft, fluid-based target such as human tissue or ballistic gelatin. In this study, JHP bullets were fired into ballistic gelatin after passing through selected intermediate targets representing items common to shooting incidents. Velocity loss and bullet destabilization were not factors that contributed to the JHP bullets that experienced expansion failure; however, materials obstructing the bullets' cavities and damage to the bullets' cavities were considered causes for some of the JHP bullet expansion failures. It was determined through this research that most of the target materials caused JHP bullet expansion failure when shored against the ballistic gelatin, but when placed at distances of 7 ft. from the ballistic gelatin, bullets fired through the same target materials did expand. This original and unique study produced findings that are of significant value to shooting incident reconstruction experts and other forensic professionals as shooting incidents can call into question a victim's proximity to a wall or door when a bullet(s) perforated such a target material.     

具有前置物的枪弹创射入口的形态学研究

对11例枪弹贯通障碍物后射入人体所形成的射入口的形态进行了观察与研究。结果表明，有前置物的射入口与单纯枪弹射入口的形态有明显不同，且受多种因素影响，形态各异。根据11例有前置物的射入口形态特征，分为混合及单纯两种类型，并对其形成机理、诊断依据以及实际应用意义进行了讨论。     

Wound production by ricocheted and destabilized bullets

Bullets destabilized by ricochet or as the result of an impact with some intervening object experience a yawing to tumbling motion in flight. As a result, they often produce atypical entry wounds, but, as will be demonstrated in this article, this is not a certainty and such bullets can produce normal-appearing entry wounds. It is these wounds that are more difficult to recognize as the consequence of a ricocheted or deflected bullet at the time of autopsy. With few exceptions, ricocheted or deflected bullets also acquire characteristic damage and trace evidence inclusions that often survive the wound production process. A careful inspection of such bullets at the time of recovery will usually reveal such ricochet damage. Moreover, the instability of ricocheted bullets alters their soft-tissue penetration behavior in 2 possible ways. Destabilized full-metal-jacketed bullets will typically penetrate less than direct strikes by the same bullet. Destabilized jacketed hollow-point bullets will often fail to expand and subsequently penetrate more deeply than direct shots with the same bullet.     

9mm警用转轮手枪橡胶弹射入口的形态特征

目的观察橡胶弹射人口的形态特征,并探讨其法医学意义。方法使用9mm警用转轮手枪发射橡胶弹,在实验动物胸腹部侧面垂直射击,射击距离分别为紧密接触射击（0cm）,相对接触射击（1～6cm）,近距离射击（6-60cm）和远距离射击（60cm～有效射程25m）。92式手枪采取相同方式射击实验动物作为对照。观察射入口的形态特征,制作组织病理学切片,HE染色显微镜下观察。结果橡胶弹接触射击和近距离射击,射入口边缘整齐,有明显的擦拭轮、挫伤轮和火药斑纹;远距离射击,可见射人口边缘撕裂,挫伤轮明显增宽,皮下出血显著;与手枪弹射入口形态特征明显不同。结论9mm警用转轮手枪橡胶弹射入口典型的形态特征,可作为此类损伤的诊断指标。     

跳弹创形态学的实验研究

目的 探讨跳弹创形成的条件,研究跳弹在体内弹道学特点及致伤能力,建立跳弹创的诊断依据。方法选用国产54式手枪及56式半自动步枪,配用51式手枪弹及56式步枪弹以水磨石板为反跳靶体,射击约克夏种猪4头,复制出跳弹创模型12例。观察射入口、创道及着弹点特征。结果 跳弹的形成受靶体性状、弹头形态和速度、入射角与反跳角等条件因素的影响;在相同条件下高初速尖型弹头的反跳角<低初速圆型弹头;创道无明显瞬时空腔效应;根据实验结果建立了6项诊断依据。结论 正确诊断跳弹创对射击方向和距离、重建弹道、分析枪击目的、评估损伤程度有实用价值。     

Metallization at the Exit Wound—An Unusual Finding in Fatal Electrocution

Electrocution injuries represent a severe occupational hazard. Those at work usually ignore the importance of safety training and safe practices while the electric source is nearby the work area. Death due to electrocution can occur with or without any electric mark on the body. Limbs are the commoner site for electric entry and exit wounds. Various uncommon sites for electric exit wounds have also been reported in the literature. We report a rare case of fatal electrocution, where a 28-year-old male carpenter sustained electric injuries at the worksite. Multiple exit wounds were present over the back of the chest, an uncommon site for the exit wounds, and notably, both entry and exit wounds showed evidence of metallization. The present case emphasizes on the significance of death scene investigations in the reconstruction of events and need for complete autopsy supplemented with chemical and histopathological examination of the electric wounds.     

An Analysis of the Characteristics of Thoracic and Abdominal Injuries Due to Gunshot Homicides in Israel

De‐identified wound data from 197 homicidal gunshot postmortems were obtained between 2000 and 2008. Forensic ballistics data were only available for cases between 2004 and 2008. Males represent 91% of gunshot victims and were struck in the thorax/abdomen with an average of 2.3 bullets. The type of firearms involved were semi‐automatic pistols in the predominant caliber 9‐mm Luger and assault rifles in caliber 5.56 × 45 mm and caliber 7.62 × 39 mm Soviet, using full metal jacket bullets. The majority of shootings occurred at ranges of 1 m or greater. The most common bullet path was front to back in 66% of cases. Entry wounds occurred more often on the left side of the thorax, abdomen, and back. The most common critical organs/tissues to sustain bullet trauma in descending order were as follows: heart, lungs, liver, aorta, spleen, kidneys, and vena cava. Ribs were struck by most bullets that entered the thorax.     

Bullet Caliber and Type Categorization from Gunshot Wounds in Sus Scrofa (Linnaeus) Long Bone

Studies on ballistic trauma to the ribs and thorax, cranium, and long bones demonstrate the potential of obtaining a bullet caliber from an entrance wound. In order to validate prior research on caliber estimation in bone tissue and assess the viability of bullet type determination based on the macroscopic evidence at the entrance wound, thirty fleshed pork (Sus scrofa) shoulders (humeri) were shot with either lead or copper jacketed bullets in one of three calibers; 0.22, 9 mm, or 0.38. Overall, our findings are consistent with previous research indicating that calibers can be grouped into “small” and “large” categories. Bullet type, lead or copper jacket, can be ascertained based on cortical flaking and the analysis of materials deposited around the entry wound. The addition of this evidence holds value in cases where no firearm or ballistic evidence is recovered from a crime scene.     

Abrasion Collar Around Shrapnel Entry Wound

Abrasion collar is usually described as a feature of bullet entry wounds caused by friction and indentation. The present case is that of the peculiar entry wound caused by a piece of flying shrapnel which was ejected from a furnace in a steel plant. The scrap metal which exploded in the plant was sourced from the West Asia region. The entry wound on the chest was circular and had an abrasion collar around it. The projectile was a cylindrical object of obscure origin. The forensic science laboratory put forth the possibility that the projectile was a component of an artillery fuze. A decades old study which employed high‐speed photography has rejected the possibility that abrasion collars are produced by friction. High‐velocity projectiles other than bullets can also produce abrasion collars as the rubbing of the bullet against the skin or its rotation are not the causative mechanisms.     

Postmortem Computed Tomography and Magnetic Resonance Imaging of Gunshot Wounds to the Neck

Postmortem magnetic resonance imaging (MRI) is rarely used for the radiologic assessment of gunshot injuries, although it has clear advantages over postmortem computed tomography (CT) with regard to the imaging of soft tissue injuries. Another benefit in using MRI is that lodged projectiles composed of nonferromagnetic material such as lead present only marginal metal artifacts compared with severe artifacts on CT. This case report presents CT and MRI findings in a case with two gunshot wounds to the neck: a perforating wound and a nonperforating wound with a lead bullet lodged in the cervical spine. The decedent underwent CT and MRI before the scheduled autopsy. A ring of radiopaque material under the dermis in the fatty tissue was identified at both entrance wounds on CT, which was indicative of contact shots. The perforating gunshot was clearly indicated on CT by bullet fragments along the wound channel through the perforated 6th cervical vertebra and the fractured cricoid cartilage at the exit wound. The second trajectory, however, was only assumed based on the presence of gunshot residues at the entrance wound and the position of the lodged bullet. The radiologic assessment was severely impeded by the metal artifacts on CT. Barely noticeable metal artifacts on MRI allowed for clear visualization of the soft tissue injuries and the ruptured medulla oblongata. Only MRI clarified the soft tissue injuries of the brainstem noninvasively, which could provide specific and graphic information on the rapidity of death and the incapacitation of the victim.     

Immunocytochemical examinations of biological traces on expanding bullets (QD-PEP)

When a crime victim has been injured with several different objects, it is of central importance for the forensic investigation to be able to show which object caused which injury, especially if one of the injuries was lethal. In cases of bullet penetration wounds it is often not possible to find such evidence. However, immunocytochemical investigations can accurately match a victim's injury to a particular bullet path through the body. In cases where expanding bullets have been used and the heart or liver has been struck by a projectile, it can be shown that the cells remaining on the bullet stem from those particular organs. In this case the specific cytological evidence was established by means of marking heart- and liver-specific tissue proteins with appropriate antibodies (cardiac troponin I and HepPar 1) followed by disclosure with an appropriate chromogen. Thus, in principle, cells can be used as evidence after being extracted from the projectiles by either damp cotton-wool swabs or adhesive trace evidence tape. Because of the specificity of the used immunocytochemical antibodies, finding evidence of an antigen on a particular projectile proves that it was the object that injured the organs.     

Radiodense bullet wipe around osseous entrance gunshot wounds

“Bullet wipe” is the material deposited by a bullet on any surface with which it comes into contact after it is fired and may contain debris from the gun barrel, including particles of primer and metal fragments from previously fired bullets. X‐ray analysis is a non‐destructive method by which traces of metallic elements can be visually detected. The analysis of osseous defects for radiodense bullet wipe (RBW) assists in determining the presence or absence of perforating gunshot wounds, especially in fragmented, skeletonized remains. The aim of our current study was to determine the frequency of RBW around entrance firearms injuries that perforated bone. We prospectively analyzed entrance gunshot wounds for RBW over a three‐year period using digital X‐ray analysis (n = 59). We retrospectively reviewed the corresponding autopsy reports to determine the frequency of RBW by biologic sex, reported ancestry, age‐at‐death, location of wound, manner of death, range of fire, bullet caliber, and presence of bullet jacket. Data were analyzed by Fisher's exact test or Chi‐square test with significance levels accepted at p < 0.05. RBW was present in 66% (n = 39) of examined cases. Decedent characteristics did not significantly alter RBW distribution, including biologic sex (p = 0.75), reported ancestry (p = 0.49), and age‐at‐death (p = 0.43). Additionally, the location of the osseous entrance gunshot wound, manner of death, range of fire, and cartridge caliber did not affect RBW detection. All cases involving non‐jacketed rounds (n = 5) showed RBW (p = 0.30). To our knowledge, this study is the first to report the frequency of RBW detection from osseous entrance gunshot wounds.     

Discordance of Gross and Histologic Findings in Estimating the Range of Fire of Gunshot Wounds

Forensic pathologist use soot and/or stippling surrounding entrance gunshot wounds in categorizing range of fire. If absent, some pathologists suggest utilizing histology when the range is diagnostically critical. This study investigates the concordance of macroscopic and microscopic findings in estimating range of fire by evaluating gunshot entrance and exit wounds made through human tissue analogs at defined distances using two handgun calibers. Examination of over 150 entrance wounds verified the ease of visually detecting soot from a muzzle distance of contact to 1 foot (30.5 cm), and its absence at 9 feet (274.3 cm). Distinctly apparent was bullet wipe surrounding the entrance wounds regardless of muzzle distance. Although variations existed, dark material was histologically identified in many skin, soft tissue, and bone sections at all ranges with both calibers. These nonparallel results decrease the dependability of histology for range of fire estimation and reinforce using gross observation.     

Effect of clothes on the size of gunshot wounds made by long-distance shots with small-calibre bullets

An experimental study was made on estimation distance of shots made from far distance through clothes with 5.6-mm jacket-free lead bullets. Textile obstructions imitating human clothes were modeled. Contact velocity of the wounding bullet was measured. Almost complete forensic-medical characteristics of inlet gunshot wounds of the body allowing for clothes properties, anatomic structure of the affected body area, deformation of the hitting bullets were obtained.     

A Ballistics Examination of Firearm Injuries Involving Breast Implants

This ballistics study examines whether saline breast implants can decrease tissue penetration in firearm injuries. We hypothesize that the fluid column within a saline breast implant can alter bullet velocity and/or bullet pattern of mushrooming. The two experimental groups included saline implants with 7.4 cm projection and a no implant group. The experimental design allowed the bullet to pass‐through an implant and into ballistics gel (n = 10) or into ballistics gel without passage through an implant (n = 11). Shots that passed through an implant had 20.6% decreased penetration distance when compared to shots that did not pass‐through an implant; this difference was statistically significant (31.9 cm vs. 40.2 cm, p < 0.001). Implant group bullets mushroomed prior to gel entry, but the no implant group mushroomed within the gel. Bullet passage through a saline breast implant results in direct bullet velocity reduction and earlier bullet mushrooming; this causes significantly decreased ballistics gel penetration.     

枪弹创前置物射入口形态学的实验研究

为建立前置物射入口与典型射入口的检验鉴别方法，使用国产54式7.62mm口径手枪及56式7．62mm口径半自动步枪，以3m的距离射击约克夏种白猪义3只，同时以各种玻璃、木板。汽车门、动物躯干等物质作为中间障碍物，制成前置物射入口36例，并与对照组6例射入口进行对比观察。结果显示，前置物射入口较典型射入口增大，撕裂，创线挫伤增宽，创周出现卫星创或假点彩，创道内异物及弹头严重变形。此检验诊断方法有助于法医在实际检验中对射击距离的判断和对现场环境的分析。