Broncholithiasis mimicking metallic projectiles at autopsy: a forensic diagnostic pitfall in putrefied bodies.
Aymeric Zambiasi, Eulalie Pefferkorn, Fabrice Dedouit et al.
✦ AI-curated · Sources linked
Case in brief
At medico-legal autopsy, a 76-year-old man found in advanced putrefaction had small, hard intrapulmonary nodules that raised suspicion of retained pellets. Post-mortem CT showed multiple hyperdense micronodules in the right upper lobe, aligned along an endobronchial course and lacking metallic artifacts. Scanning electron microscopy with energy-dispersive X-ray spectroscopy found predominantly calcium and phosphorus, without elements typical of ballistic material. Histopathology and elemental analysis confirmed broncholithiasis, resolving the apparent projectile finding as a calcified biological process.
What made this case unusual
In a decomposed body, broncholiths resembled retained ballistic fragments on gross examination, creating a forensic risk of misinterpreting the cause or manner of death.
Diagnostic / clinical pearl
When hard pulmonary nodules in a decomposed body suggest pellets, assess their CT distribution and metallic artifacts; histopathology and elemental analysis can help distinguish broncholithiasis from ballistic material.
Why it matters
A multimodal post-mortem assessment can prevent a biological calcification from being misclassified as evidence of gunshot injury.