An Atypical, Indeterminate-Range, Cranial Gunshot Wound of Entrance Resembling an Exit Wound

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A 29-year-old woman was strangled, beaten, and shot by her estranged boyfriend. According to investigative reports, she was shot once with a full-metal-jacket, .45-caliber bullet fired from a Ruger P90 at 30–40 cm. A stellate, irregular wound was on the right cheek and a larger stelliform defect with three radial tears but no obvious central perforation involved the left occipital scalp. Radiographically, the wound at the back of the head exhibited external beveling and a small metallic fragment was visible in the overlying soft tissue. Further examination of the occipital wound revealed partial external beveling and circumferential, complete internal beveling characteristic of an entrance gunshot wound. Although external beveling of entrance gunshot wounds has been previously described, this unique case illustrates a cranial entrance wound of indeterminate range exhibiting an atypical, stelliform skin defect with subtle marginal abrasion, no discernible central perforation, and subjacent external beveling mimicking an exit wound.

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