Massive internal injury in the absence of significant external injury after collisions of passenger vehicles with much larger vehicles.

We have encountered cases of motor vehicle collisions in which there was relatively little external trauma, but there were massive internal injuries that were much more extensive than might be expected from the external examination. Two cases were collisions between trains and pickup trucks, the third a collision between a semi trailer and a van. In all three cases, the external examination showed minor abrasions and lacerations. Internally, however, there were massive injuries which were fatal. While the significant injuries in our cases were not surprising given the force of the collisions involved, it is interesting that the external examination showed relatively little injury. We speculate that collisions between passenger vehicles and very large vehicles generate massive internal injuries by transmission of force through the victims.