An Unusual Case of Fatal Thoracoabdominal Gunshot Wound without Diaphragm Injury

In case of thoracoabdominal gunshot wounds (GSW), diaphragmatic lesions are common autopsy findings. In these cases, the bullet's path involves both the thorax and the abdomen, so the diaphragm (the muscle that separates the two cavities) is frequently damaged. In the present report we illustrate a very unusual autopsy finding, came up after a man was shot twice and affected by a lethal thoracoabdominal gunshot wound. In particular, as expected based on CT scans, the corpse exhibited a thoracic-abdominal path and a retained bullet in the abdomen, but no diaphragmatic lesions or hemorrhagic infiltrations of this muscle have been detected during the autopsy. After a scrupulous examination and the section of all the organs, the intracorporeal projectile's path was reconstructed, inferring that the thoracoabdominal transit of the bullet extraordinarily had occurred in correspondence of the diaphragmatic inferior vena cava's ostium, thus exploiting a natural passage without damaging the diaphragmatic muscle.