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Unusual trajectory of a bullet from the shoulder to the brain: an emergency department perspective on finding a missing bullet
  1. Zofishan Anwar,
  2. Erum Shakeel,
  3. Shahan Waheed and
  4. Muhammad Baqir
  1. Emergency Medicine, The Aga Khan University Hospital Main Campus Stadium Road, Karachi, Pakistan
  1. Correspondence to Dr Zofishan Anwar; zof.anwar{at}


Terminal ballistics continues to struggle with bullet trajectory reconstruction and interpretation. This is a case of a young man presented with a very unusual trajectory of a bullet from the left shoulder to the brain parenchyma. The single wound and altered mentation prompted a CT head and neck scan, which revealed a retained bullet in the brain parenchyma, traversing from the left shoulder, across the neck and into the brain without causing significant damage to vital organs. We managed the patient conservatively. Emergency physicians dealing with gunshot injuries should thoroughly search for the bullet in cases where only a single wound is present and the bullet is missing, and they should have a basic understanding of the ballistics to understand the mechanism and injury pattern sustained by the bullet. This atypical ballistic trajectory scenario emphasises the need to exercise vigilance in accurately predicting the trajectory when the ballistic route is unknown.

  • Emergency medicine
  • Trauma
  • Trauma CNS /PNS
  • Neurosurgery

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  • Contributors ZA, ES, SW were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. ZA, ES, SW, MB gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.