Case: A twenty-year old man was found supine on Thompson Creak Trail with a bullet wound. The entrance of the wound was on the left lateral side 1 cm above the third rib. The exit wound was 5 cm above the belly button in the umbilical region. While tracing the bullet path you notice at the entrance the bullet travels in the frontal plane with a 45-degree downward angle. On inspection of the right side of the rib cage by x-ray you observe the 8th rib fractured. Fragments of the bullets are then traced to the final exit wound.
Leading Differential Diagnosis: The bullet punctured the heart or a main artery to the heart when it entered, as it was on the left side below the third rib, which would cause death
Alternatives:
1) The bullet punctured the lungs and heart (3rd rib on the left) and his liver (8th rib) and he ultimately died from internal bleeding
2) The bullet punctured his liver (8th rib) and he died from the toxins released into his body.
3) The bullet went through his lung(3rd rib) which then filled up with fluid and he choked/drowned.
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