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Bullet wound

Etiology: • Man-made injury

Pathogenesis: • Perforation of the pericardium and adjoining pleura results in a massive hemorrhage into the pericardial sac draining into the pleural cavity, with death due to exsanguination. • A bullet tract which perforates the pericardium and heart without communication with a pleural cavity results in instantaneous death due to cardiac tamponade.

Epidemiology: • (Opinion) Factors include poverty, drugs, escalation of frequency and intensity of television and motion picture violence, Civil Liberties Union and the National Perforation Rifle Association.

General Gross Description: • The bullet tract can involve any of the anatomical compnents of the heart. • The wounds in the wall are larger, when the perforation occurs in a chamber in diastole.

General Microscopic Description: • Disruption and fragmentation of the tissues are seen with extensive interstitial hemorrhage in the tissues adjoining the tract. • Early infiltration of neutrophiles may be seen in cases surviving for a matter of a few minutes, when there is a pericardial drainage into the pleural cavity.

Clinical Correlations: • Every scenario is unique, a "singularity".

References: •1.Adelson, Lester, MD. The Pathology of Homocide. Charles C. Thomas, Publishers 1974. pp.268-270. UCHC library number W 860 A221P.