Bone marrow edema induced by a bullet after a self-inflicted accidental firing

Area of Science:

• Forensic pathology
• Radiology
• Trauma imaging

Background:

• A 92-year-old male was discovered deceased.
• The scene suggested a potential traumatic event.

Observation:

• Postmortem magnetic resonance imaging (PMMR) identified bone marrow edema.
• The edema was indirectly associated with a projectile injury.
• Postmortem computed tomography angiography (PMCTA) revealed a left femoral vein laceration with contrast extravasation.

Findings:

• The projectile narrowly missed bone, causing indirect trauma.
• Pulmonary fat embolism was diagnosed.
• Significant blood loss was noted.

Implications:

• This case highlights the utility of PMMR and PMCTA in evaluating subtle projectile injuries.
• It demonstrates how indirect trauma can lead to significant complications.
• The findings underscore the combined role of fat embolism and hemorrhage in post-traumatic mortality.