Keyhole exit in a gunshot wound

The distinction between entrance and exit wounds is the most important parameter that must be determined at autopsy of gunshot victims. This is easily made out when standard firearm and ammunition are used. However, it becomes difficult when a country-made gun is used, which produces an atypical gunshot wound. A keyhole lesion is one such example, which is usually seen at the site of entry wound. We present a case report of keyhole exit of the skull, reinforcing the fact that such a lesion should not be interpreted as an indicator of the entrance gunshot wound.