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Virtual Autopsy: Preliminary Experience in High-Velocity Gunshot Wound Victims¹

¹ From the Department of Radiologic Pathology, Armed Forces Institute of Pathology, Alaska and Fern Streets NW, Washington, DC 20306-6000 (A.D.L., R.M.A., H.T.H.); Office of the Armed Forces Medical Examiner, Armed Forces Institute of Pathology, Rockville, Md (C.T.M., J.M.G., L.P.); Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (R.M.A.); Departments of Radiology and Nuclear Medicine (A.D.L., R.M.A., H.T.H.) and Surgery and Military and Emergency Medicine (H.R.C.), Uniformed Services University of the Health Sciences, Bethesda, Md. Received June 13, 2005; revision requested August 2; revision received August 3; accepted September 6; final version accepted October 4. Supported by a grant from the Defense Advanced Research Projects Agency. Address correspondence to A.D.L. (e-mail: levya{at}afip.osd.mil).

View larger version (113K): [in a new window]   Figure 1a: Lethal gunshot wound to the chest. (a, b) Transverse nonenhanced CT image shows the entry wound as an irregular linear soft-tissue defect in the right anterior chest (arrow in a) with associated subcutaneous gas. The bullet passed from right to left through the midthoracic vertebral bodies. Bone fragments are present to the left of the vertebral body (arrows in b). The displacement of bone fragments leftward indicates the direction of the bullet path. There are retropulsed fragments within the spinal canal. The bilateral hemothoraces resulted from aortic transection, which was not evident at CT. The aorta is collapsed and not visualized. (c) Surface-rendered image of CT data shows the entry wound lateral to the right nipple (arrow). (d) Correlative photograph at autopsy shows the entrance wound. (e) Photograph at autopsy shows bone fragments protruding from the midthoracic spine (arrows), angled in the direction of the path of the bullet.

View larger version (81K): [in a new window]   Figure 1b: Lethal gunshot wound to the chest. (a, b) Transverse nonenhanced CT image shows the entry wound as an irregular linear soft-tissue defect in the right anterior chest (arrow in a) with associated subcutaneous gas. The bullet passed from right to left through the midthoracic vertebral bodies. Bone fragments are present to the left of the vertebral body (arrows in b). The displacement of bone fragments leftward indicates the direction of the bullet path. There are retropulsed fragments within the spinal canal. The bilateral hemothoraces resulted from aortic transection, which was not evident at CT. The aorta is collapsed and not visualized. (c) Surface-rendered image of CT data shows the entry wound lateral to the right nipple (arrow). (d) Correlative photograph at autopsy shows the entrance wound. (e) Photograph at autopsy shows bone fragments protruding from the midthoracic spine (arrows), angled in the direction of the path of the bullet.

View larger version (143K): [in a new window]   Figure 1c: Lethal gunshot wound to the chest. (a, b) Transverse nonenhanced CT image shows the entry wound as an irregular linear soft-tissue defect in the right anterior chest (arrow in a) with associated subcutaneous gas. The bullet passed from right to left through the midthoracic vertebral bodies. Bone fragments are present to the left of the vertebral body (arrows in b). The displacement of bone fragments leftward indicates the direction of the bullet path. There are retropulsed fragments within the spinal canal. The bilateral hemothoraces resulted from aortic transection, which was not evident at CT. The aorta is collapsed and not visualized. (c) Surface-rendered image of CT data shows the entry wound lateral to the right nipple (arrow). (d) Correlative photograph at autopsy shows the entrance wound. (e) Photograph at autopsy shows bone fragments protruding from the midthoracic spine (arrows), angled in the direction of the path of the bullet.

View larger version (143K): [in a new window]   Figure 1d: Lethal gunshot wound to the chest. (a, b) Transverse nonenhanced CT image shows the entry wound as an irregular linear soft-tissue defect in the right anterior chest (arrow in a) with associated subcutaneous gas. The bullet passed from right to left through the midthoracic vertebral bodies. Bone fragments are present to the left of the vertebral body (arrows in b). The displacement of bone fragments leftward indicates the direction of the bullet path. There are retropulsed fragments within the spinal canal. The bilateral hemothoraces resulted from aortic transection, which was not evident at CT. The aorta is collapsed and not visualized. (c) Surface-rendered image of CT data shows the entry wound lateral to the right nipple (arrow). (d) Correlative photograph at autopsy shows the entrance wound. (e) Photograph at autopsy shows bone fragments protruding from the midthoracic spine (arrows), angled in the direction of the path of the bullet.

View larger version (149K): [in a new window]   Figure 1e: Lethal gunshot wound to the chest. (a, b) Transverse nonenhanced CT image shows the entry wound as an irregular linear soft-tissue defect in the right anterior chest (arrow in a) with associated subcutaneous gas. The bullet passed from right to left through the midthoracic vertebral bodies. Bone fragments are present to the left of the vertebral body (arrows in b). The displacement of bone fragments leftward indicates the direction of the bullet path. There are retropulsed fragments within the spinal canal. The bilateral hemothoraces resulted from aortic transection, which was not evident at CT. The aorta is collapsed and not visualized. (c) Surface-rendered image of CT data shows the entry wound lateral to the right nipple (arrow). (d) Correlative photograph at autopsy shows the entrance wound. (e) Photograph at autopsy shows bone fragments protruding from the midthoracic spine (arrows), angled in the direction of the path of the bullet.

View larger version (93K): [in a new window]   Figure 2a: Features of a gunshot wound to the head at virtual autopsy. (a, b) Transverse CT images of a lethal gunshot wound to the head show multiple calvarial fractures, posterior settling of the brain, and pneumocephalus. Metallic fragments and foci of gas are present in the left cerebellum in b. A distinct linear bullet track is not present. (c) Three-dimensional volume-rendered image of the skull shows the comminuted fracture of the posterior skull.

View larger version (104K): [in a new window]   Figure 2b: Features of a gunshot wound to the head at virtual autopsy. (a, b) Transverse CT images of a lethal gunshot wound to the head show multiple calvarial fractures, posterior settling of the brain, and pneumocephalus. Metallic fragments and foci of gas are present in the left cerebellum in b. A distinct linear bullet track is not present. (c) Three-dimensional volume-rendered image of the skull shows the comminuted fracture of the posterior skull.

View larger version (117K): [in a new window]   Figure 2c: Features of a gunshot wound to the head at virtual autopsy. (a, b) Transverse CT images of a lethal gunshot wound to the head show multiple calvarial fractures, posterior settling of the brain, and pneumocephalus. Metallic fragments and foci of gas are present in the left cerebellum in b. A distinct linear bullet track is not present. (c) Three-dimensional volume-rendered image of the skull shows the comminuted fracture of the posterior skull.

View larger version (159K): [in a new window]   Figure 3a: Features of a pulmonary gunshot wound track shown at virtual autopsy. (a) Oblique CT image of the neck and chest shows a gunshot wound path through the trachea (arrow) and right lung apex. (b) Transverse CT image of the upper chest shows a linear high-attenuation wound track (arrow) containing numerous small cystic spaces (arrowhead). Autopsy showed a hemorrhagic defect at the site of bullet penetration of the trachea (not shown).

View larger version (127K): [in a new window]   Figure 3b: Features of a pulmonary gunshot wound track shown at virtual autopsy. (a) Oblique CT image of the neck and chest shows a gunshot wound path through the trachea (arrow) and right lung apex. (b) Transverse CT image of the upper chest shows a linear high-attenuation wound track (arrow) containing numerous small cystic spaces (arrowhead). Autopsy showed a hemorrhagic defect at the site of bullet penetration of the trachea (not shown).

View larger version (171K): [in a new window]   Figure 4a: Lethal gunshot wound to the chest. Bullet entered through the right shoulder and passed through the right scapula, right lung apex, pulmonary trunk, pericardium, and lingula. (a) Volume-rendered image of CT data shows the bullet path through the scapula (arrow). (b) Coronal CT image shows the bullet path (arrow) through the right apex with a large cavity (*). (c) Transverse CT image shows a hemopneumopericardium, collapsed heart, multiple cystic spaces (arrow) in the lingula along the bullet track, bilateral hemopneumothorax, and subcutaneous gas.

View larger version (73K): [in a new window]   Figure 4b: Lethal gunshot wound to the chest. Bullet entered through the right shoulder and passed through the right scapula, right lung apex, pulmonary trunk, pericardium, and lingula. (a) Volume-rendered image of CT data shows the bullet path through the scapula (arrow). (b) Coronal CT image shows the bullet path (arrow) through the right apex with a large cavity (*). (c) Transverse CT image shows a hemopneumopericardium, collapsed heart, multiple cystic spaces (arrow) in the lingula along the bullet track, bilateral hemopneumothorax, and subcutaneous gas.

View larger version (106K): [in a new window]   Figure 4c: Lethal gunshot wound to the chest. Bullet entered through the right shoulder and passed through the right scapula, right lung apex, pulmonary trunk, pericardium, and lingula. (a) Volume-rendered image of CT data shows the bullet path through the scapula (arrow). (b) Coronal CT image shows the bullet path (arrow) through the right apex with a large cavity (*). (c) Transverse CT image shows a hemopneumopericardium, collapsed heart, multiple cystic spaces (arrow) in the lingula along the bullet track, bilateral hemopneumothorax, and subcutaneous gas.

View larger version (77K): [in a new window]   Figure 5: Lethal gunshot wound to the orbit and head. Transverse CT image shows three distinct metallic fragments in the brain parenchyma that correlate to the jacket (straight arrow), penetrator (arrowhead), and a fragment of the lead core (curved arrow). There are multiple calvarial fractures, pneumocephalus, and destruction of the left orbit.