Pseudo-gunshot wound injury from perforating rib fracture: a cautionary case report

We report a case of a young woman who was found unresponsive in a garbage dumpster beneath the balcony of her 9th floor apartment residence. Initial investigations by the police and coroner raised concerns regarding the circumstances of the death. Initial examination of the body, revealed a single penetrating injury on the chest with a wide abrasion collar––the injury pattern was similar to a gunshot entry wound or a shored exit wound. Autopsy revealed the abraded skin perforation along with major chest injuries with bruising of the chest wall, extensive comminuted rib fractures, and pleural and lung lacerations. These injuries were consistent with the effects of a fatal descent from height. The penetrating injury with the abrasion collar was due to a fractured end of a rib protruding through the skin mimicking a gunshot wound. The involvement of a firearm was further excluded by postmortem radiography (no projectile in situ), detailed external examination of the clothing, and scene investigation revealing that the decedent had descended from a balcony into the dumpster. This case underscores the concept that all round penetrating wounds with abrasion collars are not gunshot injuries.