Remote Internal Injuries

Ocular findings may be seen with contact head wounds. Periorbital hemorrhages ("raccoon eyes") caused by orbital plate fractures from brain impact and cerebrospinal fluid pressure can be seen (see Subheading 19.3.; Fig. 48). Petechiae of the eyes have been associated with contact wounds of the head and neck and are likely secondary to gas expansion, particularly if these wounds are in proximity to the orbit (155). Ocular petechiae also have been seen in a case of a shotgun injury of the neck (155). Scleral and conjunctival hemorrhages have arisen from a venous pressure wave owing to a contact gunshot wound of the chest inflicted by a .357 magnum revolver (112).

Fig. 45. Self-inflicted shotgun wound of face. Delayed death from sepsis.
Fig. 46. Intracranial gunshot wounds. (A) Gunshot entry. Inner table of skull: "beveled-in." (B) Gunshot exit. Outer table of skull: "beveled-out."

The effects of gas or "blast injury" owing to close-range discharge can result in vessel tears. For example, vascular rupture has been seen without an associated wound track in a tear gas cartridge discharge (93). A blank cartridge, which inflicted a neck wound, has been observed to cause carotid artery and jugular vein lacerations (92). A cardiac laceration has resulted from a blank cartridge discharge on the chest (73).

Fig. 47. "Keyhole" defect of skull. (A) Distant gunshot wound, right forehead. (B) "Keyhole" defect on skull (direction of bullet—arrow). (Courtesy of Dr. E. Tweedie, London Health Sciences Centre, London, Ontario, Canada.)

Wounds involving the head and other sites (e.g., abdomen) are associated with visible subendocardial hemorrhage in the interventricular septum (Fig. 52; ref. 208). Blunt head trauma can also cause this. The mechanism is thought to be sympathetic overactivity and consequent catecholamine excess (208). Microscopic examination revealed myocardial contraction bands in a case of a head wound sustained from a starter's pistol (73).

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