Fig. 8

a Axial MDCTA image through the junction of the nasopharynx with the oropharynx (above the level of the endotracheal tube) in a 43-year-old man who sustained fatal perforating gunshot injury to the neck, which entered in the left zone 3 and exited through the right zone 2, having traversed the posterior oropharynx (image not shown). The pharyngeal airway at the level shown has been completely obliterated by haematoma and oedema. Pharyngeal projectile penetrating injuries, in the absence of major vascular injury, are frequently fatal due to airway compromise from haematoma, oedematous swelling and haemorrhagic debris. b Axial CT image of the same patient as in 8a on bone-window settings through the superior oropharynx (slightly inferior to the level in a). There is fracture disruption of the right lateral mass of the atlas (C1) at the junction with the anterior arch as well as fracture of the posterior aspect of the right ramus of the mandible cause by the bullet (which exited through zone 2 on this side). Soft tissue emphysema and swelling is evident in the right prevertebral, parapahryngeal and masticator spaces. The endotracheal tube is demonstrated. c Non-contrast CT brain of the same patient as in a and b performed 2 days later, demonstrating severe generalised hypoxic ischaemic encephalopathy with symmetrical subacute low attenuation change identified in the basal ganglia at this level as well as evidence of significant cerebral oedema and swelling. Brain stem death was subsequently confirmed and intensive care support withdrawn