Subendocardiac hemorrhage in firearm injuries : a postmortem hallmark of high velocity missile injuries

Abstract EN

Energy produced by the high velocity missiles will create within milliseconds a cavity in the tissue and results in stretching, compression, shearing, and damage of tissue that may extend several centimeters away from the bullet and its track.

Moreover, a transonic shock waves will be produced which may cause additional tissue damage in organs that are far away from the track of the missile.

Thus, vessels, nerves, and structures that were never in direct contact with the missile may be damaged.

During routine examination of the heart in high velocity bullet injury victims, we frequently observed the presence of areas of subendocardiac hemorrhages, varied from several cm2 – all ventricular wall, especially in those whose injuries were in the thorax, upper limbs, head, and neck.

These observations stimulated us to carry out this study in order to reveal the frequency, significance, and pathogenesis of these lesions.

Patients and methods.

The study included 81 patients; 31 patients who died from injuries by high velocity bullet and considered as the study group, and 50 patients who died from other causes and considered as control group.

For each patient a full autopsy was performed and the heart was carefully examined.

Data concerning the subendocardiac hemorrhages, their locations and extent were done.

Comparison was made between the study and control groups.

Results of our study have shown that sudendocardiac hemorrhages were present in 83 % of patients who died from high velocity bullet injury.

However there were variations in frequency for each region ; they were present in 100 % of patients whose bullet injuries were in the head and neck, in 86 % of patients whose injuries were in the chest and upper limbs, and in 20 % of those whose injuries were in the abdomen and lower limbs.

These lesions were mostly located at the posterior wall of the left ventricle.

They varied in extents from few centimeters to involve nearly the entire surface area of the posterior wall of the ventricle.

None of the control group has shown these lesions.

Conclusions.

The hemorrhagic lesions demonstrated in the left ventricle following high velocity bullet injuries are most probably produced by the indirect effect of the high velocity missiles on the subendocardium through the transonic waves produced by the missile during its passage near the heart.