Case: A twenty-year old man was found supine on Thompson Creak Trail with a bullet wound. The entrance of the wound was on the left lateral side 1cm above the third rib. The exit wound was 5cm above the belly button in the umbilical region. While tracing the bullet path you notice at the entrance the bullet travels in the frontal plane with a 45-degree downward angle. On inspection of the right side of the rib cage by x-ray you observe the 8th rib fractured. Fragments of the bullets are then traced to the final exit wound.
Hypothetic Situation: The young rising movie star went out for a walk along Thompson Creak Trail. Little did he know that he was followed by his pyschopathic colleague, who was jealous of his talents. The psycho shot him across the trail, which was on the movie star's left-hand side. unfortunately, the past rising star became today's falling star.
The leading differential diagnosis is the massive internal blood loss resulted from the bullet injuring his heart and/or the aorta of his heart, since the entrance of the wound was on the left lateral side 1cm above the third rib.
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The main organ under the ribs on the left side is the heart. Other organs in this location are the left lung, spleen and left kidney. |
Another possible cause of his death might be the bullet went through and damaged his lung that he was unable to breathe. Yet, this possibility could rule out by an autopsy and examination of lungs. Also, on inspection of the right side of the rib cage by x-ray we observe the 8th rib fractured. The fractured rib might puncture the liver, and the liver might release toxins into his system, which could cause his death. However, this assumption could rule out after an autopsy and examination of his liver. Moreover, as stated in the case, while tracing the bullet path we notice at the entrance the bullet travels in the frontal plane with a 45-degree downward angle, and the exit wound was 5cm above the belly button in the umbilical region. This means the bullet might go through his stomach and damaged his stomach. The harmful acids in his punctured stomach might corrode his other organs and tissues causing damage to his other systems in the body, which might lead to his death. The same, after an autopsy and examination of his stomach, we could rule out this possibility.
On the other hand, the fractured 8th rib might be caused by him falling after he got shot. He was shot on his left lateral side, and the bullet exited 5cm above the belly button in the umbilical region. Therefore, he might feel the severe pain in his stomach that he held his belly and fell on his right side really hard; furthermore, the 8th rib locates in the right lumbar region, which is right next to the umbilical region.
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