Retrograde transthoracic venous bullet embolism. Report of a case following a single gunshot with multiple wounds in the left arm and chest

Bullet embolism of the arterial, venous and paradoxical types are well known but rare complications of penetrating missile injuries. Retrograde transthoracic venous bullet embolization is extremely rare with only four cases previously reported in the literature. Single gunshot can cause multiple wounds, mainly because the bullet passes through an intermediate target before striking the victim. We present the autopsy findings of a retrograde transthoracic bullet embolism to the right external iliac vein after a single gunshot with multiple wounds in the left arm and thorax. Problems related to medico-legal investigations of gunshots are reviewed.