The term ‘stab wound’ in the popular sense, is confined to the wound that is caused by thrusting a sharp-edged and pointed weapon like knife, dagger, etc [1]. Stab wound is a piercing wound produced by application of mechanical force along the long axis of a narrow or pointed object [2]. Types: They are called (1) Puncture wounds: When soft tissues are involved. (2) Penetrating wounds: when they enter a cavity of body or a viscus. (3) Perforating wounds or through-and-through puncture wounds: When the weapon enters the body on one side and comes out from the other side. The victim of a fatal penetrating injury may not show signs and symptoms of injury until many hours have passed [3]. The present case study aims to highlight stab injuries to lungs and discuss related to it.

A 28 years male had history of assault at 1:00 a.m. After the assault he went home and slept. In the morning he was not responding at 6 a.m. at his home and hence was brought by relatives to the casualty of the tertiary health centre. He was declared as brought dead at casualty of the tertiary health centre. The dead body was brought wrapped in a multicolour blanket. The deceased had worn One brown colour t-shirt and black coloured full track pant. There was black coloured underwear with label of “MACHO”. There was Black thread around the waist. Black thread was around the left wrist. On examination of the clothes there were two rents(stab wound defect) present over the anterolateral aspect of the left side of the t-shirt. Blood stains were also present over the t-shirt at places.

On examination of surface wounds; there was presence of a stab wound over the left side of the chest. The stab wound was 20 CM below the left axilla and 12 CM left of the left nipple. The size of the stab wound was 12 mm x 3 mm x cavity Deep. On internal examination of this stab wound there was presence of stab wound in the intercostal space between the 8 and 9 ribs on the left side at its lateral aspect. There was also presence of stab wound of size 12 mm x 2 mm x parenchymal deep present over the lateral aspect of lower lobe of the left lung. There was presence of blood and blood clot around this stab wound. And blood was seen oozing out of this stab wound [Fig 1] [Fig 3].

Figure 1:  Stab wound present over the left side of the chest

Figure 3: Stab wound over the lateral aspect of lower lobe of the left lung

Another Stab wound was present over the left side of the chest; 9 CM below the left axilla and 9 CM left of the left nipple. The size of the stab wound was 13 mm x 3 mm x muscle deep. The stab wound was placed directed medially upwards. On internal examination of the stab wound there was no any internal extension of the stab wound into the pleural space.

There were multiple incised wounds present over the forehead regions, over the left eyebrow, over the left side of the face, over the left side of the neck and also over the left side of the chest.

There was also presence of abrasions over the left elbow and over the antero-lateral aspect of the lower end of the left arm.

On internal examination there was presence of underscalp hematoma corresponding to incised wounds over the foreheads. There was no any fracture of skull vault.  Meninges and brain were found to be intact. On internal examination of Thorax; there was stab wound present on the left lung which was corresponding to the first injury mentioned in the external examination. There was presence of about 1500 grams of blood and blood clothes noted in the left pleural cavity.[Fig 2] All internal organs were pale.

Figure 2: Blood and blood clots in left pleural cavity

The cause of Death was given as “stab injury to the chest”.

Stab wound is a piercing wound produced by application of mechanical force along the long axis of a narrow or pointed object [2]. Types: They are called (1) Puncture wounds: When soft tissues are involved. (2) penetrating wounds: when they enter a cavity of body or a viscus. (3) perforating wounds or through-and-through puncture wounds: When the weapon enters the body on one side and comes out from the other side. The victim of a fatal penetrating injury may not show signs and symptoms of injury until many hours have passed [3].

Rapid accumulation of blood and air in thoracic cavity due to perforation of a lung or large bronchus can result in lethal mediastinal shift to the contralateral side. Minimal bleeding into thoracic cavity with tension pneumothorax can cause death several hours after injury. Sudden death following minor pulmonary injury can result from cardiac inhibition due to mechanical injury to the pleura. A wound of the lung causes frothiness of blood, which issues from the mouth and nose or in coughing [4].

Stab wounds of the lungs are usually not fatal, unless a major pulmonary blood vessel has been severed. Pneumothorax is common [4]. [5] Retrospectively reviewed 117 patients with stab wounds of the chest admitted to hospital over 12 years (from 1975 to 1987) revealed some factors that might influence their mortality. Seven patients died from trans-diaphragmatic injuries of intra-abdominal organs. The management of intra-abdominal injuries was very important in thoracic stab wounds. Many of the patients with stab wounds of the precordial chest (danger zone) had cardiac or major vascular injuries, and the mortality rate of them was high. Survival rate in the patients whose circulatory condition had been unstable when they admitted was very low.

In our present case, the deceased had stab wound to the left chest which extended to left lung. This stab wound to left lung had caused bleeding in left pleural cavity. As the patient didn’t collapsed immediately after the assault, the bleeding would not have been profuse immediately at the time of assualt. The bleeding would have been accumulated over a long period of time as bleeding through stab wound to lung could have continued as deceased went to his home. This sustained bleeding had caused around 1500 ml blood and blood clots to accumulate at left pleural cavity. This led to hypovolemic shock and caused death to the deceased

Conflict of Interest: None.

Acknowledgement: None

1. 1. Krishnan Vij. Textbook of forensic medicine and toxicology. 5th ed. Reed Elsevier India Private Limited. 2011; 227.
   2. Rajesh B. Principles of forensic medicine and toxicology. 1st ed. Jaypee brothers medical publishers. 201;189.
   3. Narayana Reddy KS. The essentials of forensic medicine and toxicology. 33rd ed. Jaypee brothers medical publishers. 2014;197.
   4. Narayana Reddy KS. The essentials of forensic medicine and toxicology. 33rd ed. Jaypee brothers medical publishers. 2014; 268.
      5. Yuasa H, Henmi H,  Yamamoto Y,  Mashiko K,  Koseki K,  Yasuda K, et.al.  Clinical study on stab wounds of chest factors that may influence their mortality. Nihon Kyobu Geka Gakkai Zasshi. 1989;37:1532-1536.