Two Bullet Wounds, One Bullet: The Atypical Fragmentation of a .223 Caliber Ammunition

As the fifth leading cause of death in individuals aged 1 to 64 years in the United States, forensic pathologists frequently encounter firearm-related deaths and are trained to approach these cases by utilizing information from the investigation, radiographs, and autopsy findings to discern the logical sequence of events that lead to death. We also emphasize the importance and utility of various factors such as bullet wound characteristics, type of ammunition used, and type of tissues involved in a forensic pathologist's determination of events and in medicolegal investigations. However, the unusual presentations of firearm-related deaths can cause confusion and even frustration when there are contradicting circumstances or findings at work. We present the case of a 61-year-old woman with an atypical pattern of 2 distinct irregular entrance gunshot wounds determined to be caused by a single projectile.