Scleral and Conjunctival Hemorrhages Arising from a Gunshot Wound of the Chest: A Case Report

Abstract

A young man committed suicide in the back seat of an automobile, witnessed by two law enforcement officers sitting in the front seat who had attempted to dissuade him from killing himself over an eight hour period. Death was caused by a contact gunshot wound of the anterior chest, which entered the midsternum and disrupted the anterior right atrium and ventricle of the heart, without involvement of either left ventricle or atrium. At the autopsy, bilateral fresh, confluent scleral and conjunctival sulcus hemorrhages were discovered, with no other evidence of facial or intracranial trauma. These hemorrhages are postulated to have arisen from a sudden pressure wave ascending through the superior vena cava, in a manner similar to the ocular findings associated with the retrograde venous blood flow that occurs during severe thoracic compression. These hemorrhages should not be mistaken for evidence that a decedent was beaten or otherwise involved in an assault episode.