AORTA - puncture wound

Inside the arch of the aorta just beyond the origin of the left subclavian artery there are two tears in the intima; these are associated with dissection of the adventitia.
These wounds were produced by a Ramset nail some 8.0 cm long which ricocheted and penetrated the chest wall transfixing the left upper lobe of the lung and penetrating the arch as seen here. The dissection in the adventitia extended into the pericardium proximally and to the level of the diaphragm distally. Death was from blood loss into the pleural cavity.