Heat-induced post-mortem defect of the skull simulating an exit gunshot wound of the calvarium

Abstract

Case report A severely burned body was found in a burnt-out apartment following a house fire. At the death scene, police investigators noted a defect at the back of the head of the deceased. This defect perforated the occipital bone and showed external bevelling. To clarify whether this skull wound corresponded to a gunshot exit wound and for identification purposes, a medico-legal autopsy was ordered. External examination of the body showed intense charring with skin burned away and musculature exposed, fourth degree burns of the remaining skin and heat flexures of the limbs as well as heat-related rupture of both the abdominal cavity and chest wall (Fig. 1). An oval defect of the occipital bone with cratering of the external table of the cranium was found (Fig. 2). The defect measured 2 cm in diameter, was sharp-edged and the excavation of the outer table of the cranium showed no charring in contrast to the surrounding parts of the occipital bone (Fig. 3). Apart from this finding, radiology of the body before autopsy was unremarkable. At autopsy, gross sections of the mucosa of the trachea and main bronchi were covered by a thick layer of soot with soot particles also present within the esophageus and the stomach. The brain showed a reduced volume, flattening of gyri and obliteration of sulci but no signs of trauma. Except for the defect of the occipital bone, no other signs of ante-mortem or post-mortem trauma could be detected. The level of carboxyhemoglobin in heart blood was 65% and the blood alcohol level was 285 mg/dL.