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TOXICOLOGY REPORT
Office of the Chief Medical Examiner
Toxicology Folder: T200908360
Chapel Hill, NC 27599-7580
Case Folder: F200910372
Date of Report: 09-nov-2009
Page: 1
DECEDENT: William Averitt Maxwell, Jr.
Status of Report: Approved
Report Electronically Approved By: Sandra Bishop, PhD
* * *
===============================================================================
SPECIMENS received from Christopher J. Gordon on 04-nov-2009
S090024993: 18.0 ml Blood
SOURCE: Aorta
CONDITION: Postmortem
OBTAINED: 03-nov-2009
Ethanol --------------------- None Detected
11/09/2009
_______________________________________________________________________________
S090024994: 3.0 ml Blood
SOURCE: Vena Cava
CONDITION: Postmortem
OBTAINED: 03-nov-2009
_______________________________________________________________________________
S090024995:
SOURCE:
Liver
CONDITION: Postmortem
OBTAINED: 03-nov-2009
_______________________________________________________________________________
S090024996: 15.0 ml Urine
SOURCE: Urinary Bladder
CONDITION: Postmortem
OBTAINED: 03-nov-2009
_______________________________________________________________________________
120709 10:07
*** END OF REPORT ***
B200904966
file:///M|/ONLINE%20SUPPORT/maxwell/WILLIAM%20MAXWELL--TOX.txt[12/7/2009 10:33:01 AM]
Office of the Chief Medical Examiner
CB # 7580 Chapel Hill, NC 27599-7580
Telephone 9199662253
REPORT OF AUTOPSY EXAMINATION
DECEDENT
Document Identifier
B200904966
Autopsy Type
ME Autopsy
Name
William Averitt Maxwell, Jr.
Age
47 yrs
Race
White
Sex
M
AUTHORIZATION
Authorized By
Damon K. Arrington MSN
Received From
Cumberland
ENVIRONMENT
Date of Exam
11/03/2009
Time of Exam
13:00
Autopsy Facility
Office of the Chief Medical Examiner Persons Present
Bill Holloman, Ms. Hilary Sheaves, Ms. Molly Hupp
Dr. Radisch, Dr. Simmons, Mr.
CERTIFICATION
Cause of Death
Gunshot wounds of the head and neck
The facts stated herein are correct to the best of my knowledge and belief.
Digitally signed by
Christopher Gordon
Deborah L. Radisch MD 07 December 2009 09:00
DIAGNOSES
Contact gunshot wounds of the posterior oropharynx (2)
Numerous skull fractures
Mandibular fracture
Brain laceration of anterior horn of temporal lobe
Laceration of cervical spinal cord
Subgaleal hemorrhage
Subarachnoid hemorrhage
Anterior tongue laceration
Hemorrhage of perilaryngeal soft tissues
Cardiomegaly (475 g)
Mild left ventricular hypertrophy (1.6 cm)
IDENTIFICATION
Body Identified By
Papers/ID Tag
EXTERNAL DESCRIPTION
Length
73 inches
Weight
252 pounds
Body Condition
Intact
Rigor
2+
Livor
Posterior-dependent
Hair
Gray-brown with brown mustache
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Eyes
Blue, displaced posterior in orbital sockets
Teeth
Natural dentition upper and lower
The decedent is a stated 43-year-old white male with obvious traumatic injury to the head and neck.
There is evidence of medical intervention with EKG leads on the left and right wrists, and ID bands on the left wrist and
right ankle. A well healed surgical scar is appreciated over the right patellar region.
The decedent is wearing a red plaid button down shirt, tan suit pants, and has a yellow metal ring on the left hand. He
has a brown belt, white underwear, and a wallet with miscellaneous cards and papers. The wallet contains $301. Also
found in his pockets are a set of keys, two bullets, and white paper with miscellaneous hand written notes.
INJURIES
Gunshot Wound #1
On the decedent's left of midline in the posterior oropharynx is an irregular perforation with associated mucosal
laceration and hemorrhage, consistent with an entrance gunshot wound. The wound track perforates the palate and
enters the left side of the cranial vault between the greater wing of the sphenoid and anterior temporal bones. The
anterior pole of the left temporal lobe and brain tissue immediately posterior are lacerated and disrupted. A 1 by 1 inch
displaced fracture site is identified on the left lateral aspect of the temporal and parietal bones. Associated injuries
include left-sided subgaleal (scalp) hemorrhage, diffuse subarachnoid hemorrhage, bilateral periorbital hemorrhage,
mucosal lacerations of the lower lip, disruptive lacerations of the anterior/superior tongue, and full-thickness displaced
mandibular fracture. A medium caliber lead projectile with copper jacket is recovered directly medial to the
aforementioned 1 by 1 inch temporal/parietal bone fracture. In the anatomic position, the projectile travels from front
to back, medial to left lateral, and slightly upwards.
Gunshot Wound #2
On the decedent's posterior oropharynx is an irregular perforation with associated mucosal laceration and hemorrhage,
consistent with an entrance gunshot wound. The wound track penetrates the posterior wall of the pharynx, deep
musculature of the neck, and ends midline between the C3/C4 vertebrae, damaging the spinal cord. Associated injuries
include mucosal lacerations of the lower lip, disruptive lacerations of the anterior/superior tongue, significant
hemorrhage into the perilaryngeal musculature and soft tissues, hemorrhage in the glottis and superior trachea, and
full-thickness displaced mandibular fracture. A medium caliber lead projectile with copper jacket is recovered midline
between the C3 and C4 vertebrae. In the anatomic position, the projectile travels from front to back, remains midline,
and slightly downwards.
ASSOCIATED/BLUNT TRAUMA:
The eyes have significant periorbital hemorrhage and edema, and are displaced posterior in the sockets. There is a 1 cm
horizontal laceration on the bridge of the nose. Blood is seen in the oral cavity, face, and bilateral nares. The anterior
mandible has a full-thickness longitudinal fracture with displacement. The anterior/superior tongue has a 1" region of
irregular full thickness defects and lacerations. The chin is depressed secondary to the underlying mandibular fracture,
and the lower lip shows diffuse tissue edema and mucosal abrasion with hemorrhage. There is subdermal
emphysematous changes of the head and neck.
A focal 1 cm laceration is seen on the left index finger (lateral surface).
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DISPOSITION OF CLOTHING AND PERSONAL EFFECTS
The following items are released with the body
None.
The following items are preserved as evidence
Red plaid button down shirt, tan suit pants, yellow metal ring, brown belt, white underwear, wallet with miscellaneous
cards and papers, $301, keys, two bullets, white paper with notes, blood card, and two recovered lead projectiles
received by Det. Jeff Locklear of the Fayettevile Police Department on November 9, 2009.
PROCEDURES
Radiographs
Radio-opaque objects are seen at the base of the skull near the left temporal bone, as well as in the cervical vertebra
near the C4 position. A visible full thickness longitudinal anterior mandibular fracture is appreciated with
displacement, and a complex left skull fracture is noted in the left temporal region immediately adjacent to the
radio-opaque object.
INTERNAL EXAMINATION
Body Cavities
The bilateral pleural and peritoneal cavities contain no significant fluid. No adhesions are present. All body organs are
present.
Cardiovascular System
Heart Weight
475 grams
The pericardial sac is free of significant fluid and adhesions. The coronary arteries arise normally, follow the usual
distribution and are widely patent, without evidence of significant atherosclerosis or thrombosis. The chambers and
valves bear the usual size-position relationships and are unremarkable. The myocardium shows no evidence of acute
infarction, scarring, or focal lesion. The aorta and its major branches are intact without significant atherosclerosis.
Respiratory System
Right Lung Weight
420 grams
Left Lung Weight
400 grams
The upper and lower airways are free of debris and foreign material. The lungs are normally formed. The parenchyma
of both lungs shows moderate congestion without obvious consolidation or focal lesions. The pulmonary arteries are
free of thrombi or emboli.
Examination of the soft tissues of the neck including the strap muscles, thyroid gland, and large vessels reveals
significant traumatic injury from a projectile. Once the tongue and larynx are removed, the oral cavity is re-examined.
Two projectile paths are observed. See Injuries section for complete evaluation.
Gastrointestinal System
The GI tract is intact throughout its length and is unremarkable. The appendix is present. The stomach contains
approximately 200 cc of partially digested food.
Liver
Liver Weight
1850 grams
The capsule is intact and the parenchyma is unremarkable. The gallbladder contains approximately 10 cc of bile and the
extrahepatic biliary tree is patent.
Spleen
Spleen Weight
260 grams
The spleen is normally formed; no focal lesions are present.
Pancreas
Normal size, shape and consistency without focal lesions.
Urinary
Right Kidney Weight
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150 grams
F200910372
07 December 2009 09:00
Left Kidney Weight
150 grams
The kidneys are of normal size and shape. The capsules strip with ease from the underlying smooth cortical surfaces.
The renal architecture is intact without focal lesions. The ureters are intact. The bladder contains a scant amount of
urine.
Reproductive
Grossly unremarkable.
Endocrine
The adrenal and thyroid glands are grossly unremarkable.
Neurologic
Brain Weight
1600 grams
The leptomeninges are thin, delicate and congested. There is diffuse subarachnoid hemorrhage. The cerebral
hemispheres are unremarkable. The left temporal lobe has a 3 x 2 inch region of laceration and tissue disruption. The
vasculature at the base of the brain is intact without significant atherosclerosis. Coronal sections reveal no focal lesions,
other than the aforementioned left temporal lobe tissue disruption in the wound track.
Skin
Reflection of the scalp reveals subgaleal hemorrhage associated with a left skull fracture near the left temporal region,
posterior and superior to the ear.
Immunologic System
Grossly unremarkable.
Musculoskeletal System
A 1" x 1" irregular defect of the left temporal skull is appreciated associated with fracture. This fracture site is
immediately adjacent to a recovered lead copper projectile. See Injuries section for complete evaluation.
MICROSCOPIC EXAMINATION
Cardiovascular
Sections from the interventricular septum and left ventricular free wall are free of pathological disease. There is no
evidence of acute or old infarction. An inflammatory process is not appreciated.
Respiratory
The lungs show mild anthracosis, varying degrees of atelectasis and intra-alveolar hemorrhage, and vascular
congestion. No other lesions are identified.
Liver
The liver shows slight to moderate steatosis with mild non-specific scattered lymphocytic infiltrate. Hepatocyte
necrosis is not appreciated.
Genitourinary
The kidneys show mild autolysis with no specific histopathologic abnormality.
Neurologic
A section taken near the laceration in the left anterior temporal lobe demonstrates focal acute intraparenchymal
hemorrhage. The representative section of cerebral watershed reveals no specific histopathologic abnormality.
SUMMARY AND INTERPRETATION
The decedent was a 47-year-old male who was discovered in his home along with the bodies of his wife, daughter, and
son. A handgun was discovered in his hand.
Postmortem examination shows two contact gunshot wounds of the posterior oropharynx with numerous associated
injuries including lacerations of the left anterior temporal lobe of the brain and cervical spinal cord near C3/C4.
Related injuries include mandibular fracture, several skull fractures, a tongue laceration, subarachnoid hemorrhage,
and hemorrhage into the soft tissues around the larynx. Two medium caliber jacketed bullets were recovered - one near
the left temporal bone within the cranial vault and the other from the cervical spine. Additional findings include
cardiomegaly with mild left ventricular hypertrophy, and minimal macrovesicular hepatic steatosis.
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07 December 2009 09:00
Postmortem toxicological analysis did not reveal ethanol in the aortic blood.
Based on the case history, postmortem findings, and toxicological profile, the cause of death is gunshot wounds of the
head and neck.
DIAGRAMS
1. 1. Adult (front/back)
2. 2. Head (left/right)
3. 3. Skull & scalp (top)
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