Cytologic manifestations of ballistic injury.

The adherent residue from 60 projectiles in 38 consecutive gunshot wound deaths was analyzed by cytologic technique to determine whether a bullet, while passing through the body or intermediate target, retains tissue and other trace evidence. The projectiles, which were recovered from both the body and shooting area, contained microscopically recognizable cellular and inert material in all cases. Direct ballistic trauma could be documented in several tissue types, most notably in muscular tissue. Progressive damage to skeletal and cardiac muscle was seen in multiple preparations. This ranged from partial separation of the fascicles to cytoplasmic homogenization and nuclear rupture. Except in cases of severe ballistic trauma, skeletal and cardiac muscle could be distinguished on the preparations. In addition to neural tissue, projectiles traversing the central nervous system (CNS) contained elongated fragments of intact microvascular structures, sheets of cerebral covering cells, and connective tissue from the scalp. The vascular structures present in CNS preparations may clarify some of the clinical findings in victims of gunshot wounds and elucidate possible pathophysiologic mechanisms in craniocerebral projectile injuries.