The importance of computer tomography-imaging in a case of a gunshot wound with an atypical entrance wound

Abstract

Abstract This paper is intended to demonstrate the importance of collaboration between the Radiologist and the Medical Examiner, especially in cases of firearms injuries; Computer Tomography (CT) is the method normally used, thanks to its high anatomical definition and potential for three-dimensional reconstruction and multiplanar visualisation. The case considered here concerns a shooting victim. Upon his arrival at the emergency ward two injuries were observed, one in the lower back region and a second one in the left front mid axillary line; CT-scans were taken. The entrance wound was identified as the lower back wound, which was surrounded by a margin of abrasion of eccentric shape, with burr at the bottom and on the left: this suggested that the path of the projectile was from left to right and from below upwards. The exit wound, however, was located on the left side of the front of the torso: this could be compatible with deviation of the bullet's path within the victim's body caused by having hit bones. Only analysis of CT images and three-dimensional reconstruction could permit to define the correct path of the bullet and to exclude the possibility of deviation within this path; the atypical nature of the entrance wound was therefore the consequence of a bullet which had been deformed previously. The case described demonstrates how, in presence of non-typical entrance wounds, external examination of the victim can lead to misleading conclusions, so that, even in apparently simple cases, it is essential to work with a multidisciplinary team.