title: A rock in a hard place. A brief case report.
abstract: Radiographs are often of assistance in locating foreign bodies, particularly bullets, at autopsy. It must be remembered, however, that all bullet-shaped radioopacities that appear to be within the skull are not necessarily projectiles. Described is a radiographic conundrum caused by a piece of gravel that pierced the scalp when the victim of a gunshot wound to the head fell to the ground. The stone, although bullet shaped, differed in radiodensity to metal and could have been recognized for what it was prior to much consternation on the part of the prosecutors. This case serves as a reminder of two pitfalls in the interpretation of gunshot wounds to the head. First, the radiodensity of a foreign body must be considered as important as its shape. Second, a foreign body outside of the convex surface of the skull may appear intracranial on both anteroposterior and lateral radiographs. Last, the prosecutor is encouraged to remain open minded and not to simply "see what he/she wants to see."
authors.affiliation: Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston 29425, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Cina
authors.forename: P L
authors.initials: PL
authors.lastname: Gelven
authors.forename: C A
authors.initials: CA
authors.lastname: Nichols
mesh_terms: D000293:Adolescent; D005547:Foreign Bodies / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D011859:Radiography; D012886:Skull / Q000293:injuries*; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging* / Q000473:pathology*