It is interesting to note that significant injuries, such as, rib fractures, pneumothorax, hemothorax, and contusions to the heart and lung also occurred independently of intra-thoracic penetration; including the death of a female patient who sustained left ventricle and pulmonary lacerations [1–3, 8, 9, 11, 23, 24]. In pursue of safer “”less-lethal”" impact munitions manufactures developed the attenuated SCH727965 mouse energy projectiles Syk inhibitor (AEP). These bullets were designed to duplicate the ballistic performance of the advanced plastic baton rounds but reduce the risk of serious injury in cases of inaccurate fire [2]. These types of projectiles

have a deformable head above the solid polyurethane polymer base of the standard plastic baton rounds [25]. On inadvertently hitting a hard target

like the head or the chest, the AEP should deform, spreading the impact over a greater area and a longer time period, decreasing the likely hood of serious injury and MG-132 chemical structure penetration. Furthermore, they provide better firing accuracy than previous plastic bullets, and do not fragment reducing the risk of accidental injuries [2]. However, a recent report of 13 patients demonstrated that even attenuated energy projectiles are associated with a 37% incidence of significant injuries to the head, neck, and the chest (AIS 2–5), but there were no cases of intra-thoracic penetrating [2]. Our case apparently is the first one in which there was intra-thoracic penetration by an attenuated energy projectile. In summary, to decrease serious injury caused by “”less-lethal”" impact munitions, the O-methylated flavonoid “”rules of engagement”" should be rigorously followed, even if the

munition is an AEP. Conclusion Even though the nature of the wound caused by attenuated energy bullets is generally blunt, penetration can occur specially when fired from close range at the torso. Therefore, patients who sustain less lethal ammunition injury to the chest should be thoroughly investigated with chest radiography and CT scan regardless of the ballistic features of the projectile. Consent A written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Acknowledgements Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES- Brazil) for their support. References 1. Hughes D, Maguire K, Dunn F, Fitzpatrick S, Rocke LG: Plastic baton round injuries. Emerg Med J 2005, 22:111–112.CrossRefPubMed 2. Maguire K, Hughes DM, Fitzpatrick MS, Dunn F, Rocke LG, Baird CJ: Injuries caused by the attenuated energy projectile: the latest less lethal option. Emerg Med J 2007, 24:103–105.CrossRefPubMed 3. Rocke L: Injuries caused by plastic bullets compared with those caused by rubber bullets. Lancet 1983, 8830:919–920.CrossRef 4. Ackerman BT, Ho JD: Specialty munitions. In Tactical Emergency Medicine.