Skip to main content
SpringerLink
Log in

Pulmonary embolisation of bone fragments from penetrating cranial gunshot wounds

  • Case Report
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

Bone embolism is a very rare event that usually occurs in trauma-induced septic bone lesions, after bone surgery or after bone marrow transplantation, and normally remains silent. To our knowledge, there are no previous reports of bone embolism after a gunshot to the head. We describe a case of pulmonary embolism associated with bone fragments after a gunshot to the head in which bone fragments surrounded by leukocytes, interstitial and intra-alveolar oedema and haemorrhage around the embolised vessels, leukostasis and fat and bone marrow embolism suggest that the survival time from the gunshot was sufficiently long to allow changes in lung microcirculation and lung tissue.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bollinger SA, Muehlematter K, Thali MJ, Ampanozi G (2011) Correlation of fat embolism severity and subcutaneous fatty tissue crushing and bone fractures. Int J Legal Med 125:453–458

    Article  Google Scholar 

  2. Michalodimitrakis M, Tsatsakis A (1998) Massive pulmonary embolism by liver tissue. Med Sci Law 38:85–87

    PubMed  CAS  Google Scholar 

  3. Nunes MA (1971) Pulmonary embolism by hepatic tissue. J Forensic Sci 16:57–67

    PubMed  CAS  Google Scholar 

  4. Andrew JH (1976) Pulmonary skin embolism: a case report. Pathology 8:185–187

    Article  PubMed  CAS  Google Scholar 

  5. Lau G (1995) Pulmonary cartilage embolism: fact or artefact? Am J Forensic Med Pathol 16:51–53

    Article  PubMed  CAS  Google Scholar 

  6. Brunner P, Bassermann R, Geissler KH, Kerling W (1974) Beitrag zur Frage ölhaltiger Kontrastmittelembolien. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 121:49–53

  7. Symbas PN, Harlaftis N (1977) Bullet emboli in the pulmonary and systemic arteries. Ann Surg 185:318–320

    Article  PubMed  CAS  Google Scholar 

  8. Jo C, Steed MB, Perciaccante VJ (2010) Bullet embolus to the pulmonary artery after gunshot wound to the face: case report and review of literature. J Oral Maxillofac Surg 68:504–507

    Article  PubMed  Google Scholar 

  9. Mattox KL, Beall AC, Ennix CL (1979) Intravascular migratory bullets. Am J Surg 137:192–195

    Article  PubMed  CAS  Google Scholar 

  10. Hughes BD, Vender JR (2006) Delayed lead pulmonary emboli after a gunshot wound to the head. Case report. J Neurosurg 105:233–234

    PubMed  Google Scholar 

  11. Nehme AE (1980) Intracranial bullet migrating to pulmonary artery. J Trauma 20:344–346

    PubMed  CAS  Google Scholar 

  12. Patel KR, Cortes LE, Semel L et al (1989) Bullet embolism. J Cardiovasc Surg (Torino) 30:584–590

    CAS  Google Scholar 

  13. Bining HJ, Artho GP, Vuong PD et al (2007) Venous bullet embolism to the right ventricle. Br J Radiol 80:e296–e298

    Article  PubMed  CAS  Google Scholar 

  14. Jenny-Möbius U, Bruder E, Stallmach T (1999) Recognition and significance of pulmonary bone embolism. Int J Legal Med 112:195–197

    Article  PubMed  Google Scholar 

  15. Bras JM, Veraart BE (1980) Pulmonary bone embolism after total hip replacement. J Bone Joint Surg Br 62-B:22–24

    PubMed  CAS  Google Scholar 

  16. Abrahams C, Catchatourian R (1983) Bone fragment emboli in the lungs of patients undergoing bone marrow transplantation. Am J Clin Pathol 79:360–363

    PubMed  CAS  Google Scholar 

  17. Davis GJ, McCloud LC, Nichols GR, Martin AW (1991) Cerebral tissue pulmonary embolization due to head trauma: a case report with immunohistochemical confirmation. J Forensic Sci 36:921–925

    PubMed  CAS  Google Scholar 

  18. Ogilvy CS, McKee AC, Newman NJ, Donnelly SM, Kiwak KJ (1988) Embolism of cerebral tissue to lungs: report of two cases and review of the literature. Neurosurgery 23:511–516

    Article  PubMed  CAS  Google Scholar 

  19. Tschirhart DL, Noguchi TT, Klatt EC (1991) A simple histochemical technique for the identification of gunshot residue. J Forensic Sci 36:543–547

    PubMed  CAS  Google Scholar 

  20. Rappaport H, Raum M, Horrell JB (1950) Bone marrow embolism. Am J Pathol 27:407–433

    Google Scholar 

  21. Kemona A, Nowak HF, Dzieciol J, Sulik M, Sulkowski S (1989) Pulmonary bone marrow embolism in non-selected autopsy material. Pol J Pathol 40:197–204

    CAS  Google Scholar 

  22. Zichner L (1970) Zur bedeutung der spongiosa- und knochenmarks- embolie in der lunge. Langenbecks Arch Chir 326:367–379

    Article  PubMed  CAS  Google Scholar 

  23. Nagy A (1983) Rare complication of bone fracture and bone operation: bone, muscular and bone marrow embolism (case reports). Magy Traumatol Orthop Helyreallito Seb 27:297–299

    Google Scholar 

  24. Karger B, Heindel W, Fechner G, Brinkmann B (2001) Proof of a gunshot wound and its delayed effects 54 years post injury. Int J Legal Med 115:173–175

    Article  PubMed  CAS  Google Scholar 

  25. Oemichen M, Meissner C, König HG (2001) Brain injury after survived gunshot to the head: reactive alterations at sites remote from the missile track. Forensic Sci Int 115:189–197

    Article  Google Scholar 

  26. Sinha S, Gujiar H, Sharma BS (2010) Survival after a penetrating injury traversing midbrain—case report. Br J Neurosurg 24:477–478

    Article  PubMed  Google Scholar 

  27. Petridis AK, Doukas A, Barth H, Mehdorn M (2011) Outcome of craniocerebral gunshot injuries in the civilian population. Prognostic factors and treatment options. Cen Eur Neurosurg 72:5–14

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of anatomical, histological, medico-legal and locomotor apparatus sciences, Forensic Medicine section, Sapienza University of Rome, Rome, Italy

    R. Cecchi, L. Cipolloni, C. Sestili, M. Aromatario & C. Ciallella

Authors
  1. R. Cecchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Cipolloni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Sestili
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Aromatario
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Ciallella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Cecchi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cecchi, R., Cipolloni, L., Sestili, C. et al. Pulmonary embolisation of bone fragments from penetrating cranial gunshot wounds. Int J Legal Med 126, 473–476 (2012). https://doi.org/10.1007/s00414-011-0643-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-011-0643-9

Keywords

Search

Navigation