Thoracic Multiple-Gunshot Suicide in a Homicide-Suicide Incident: An Unusual Case.

BACKGROUND Suicide involving multiple gunshot wounds is rare, representing a small subset of firearm-related suicides, and presents significant challenges in distinguishing it from homicide. This difficulty is amplified in homicide-suicide scenarios, where accurate classification has major medico-legal implications. Thoracic wounds, particularly those involving the heart, are typically rapidly incapacitating, making multiple self-inflicted injuries unusual. CASE REPORT We present a case of a 43-year-old man who fatally shot his spouse, injured his stepdaughter, and then sustained 3 gunshot wounds to the chest from a semiautomatic handgun. Autopsy revealed injuries to the heart and left lung with corresponding exit wounds on the left flank and back. No soot, stippling, or muzzle imprint was observed externally, likely due to thick clothing. Ballistic testing detected vaporous lead residues on the garment at each entrance site, while histologic analysis confirmed subcutaneous gunpowder deposition with vital reaction. Body-worn camera footage documented all 3 self-inflicted gunshots occurring within 1 second, confirming a continuous firing sequence without third-party involvement. Toxicology identified a blood alcohol concentration of 0.136%, which may have contributed to disinhibition and impulsivity. CONCLUSIONS This case demonstrates the value of integrating autopsy, histology, ballistic testing, toxicology, and digital forensic evidence in differentiating suicide from homicide in complex cases. Body-worn camera footage provided unique temporal and contextual evidence, confirming the plausibility of rapid, multiple self-inflicted gunshot wounds. Forensic practitioners should account for the potential masking effects of clothing on residue patterns and use modern investigative tools to enhance reconstruction accuracy and support definitive medico-legal conclusions.