Paul Murdaugh could have survived the first gunshot wound to his chest but the second "ejected" his brain from the top of his skull, a pathologist testified Monday at Alex Murdaugh's double murder trial.

Dr. Ellen Riemer, of the Medical University of South Carolina, performed Paul's and his mother, Maggie Murdaugh's autopsies after they were shot to death June 7, 2021, on the family's hunting estate known as Moselle.

As she graphically described Paul's injuries, Murdaugh became visibly distraught, weeping and shaking at the defense table in the Colleton County Courthouse in Walterboro, South Carolina

The disbarred attorney is accused of inflicting the horrific wounds his son and wife sustained that night.

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From left to right: Buster, Maggie, Paul and Alex Murdaugh in an undated photo. (Facebook)

Paul, 22, had his arms at his sides when he was shot in the feed room connected to the dog kennels at the 1,700-acre property in Islandton, Riemer testified.

Lead prosecutor Creighton Waters asked her whether the first shot that struck the left side of Paul's chest and exited near his armpit would have been fatal.

"No, amazingly enough," she said. "It actually did not pierce the chest or cause any internal bleeding."

The feed room where Paul Murdaugh was fatally shot at the family's sprawling hunting estate known as Moselle. (The South Carolina Attorney General's Office)

The second shot, which traveled from his shoulder, up his neck and out the top of his head, was an "extremely severe fatal injury," she testified.

"His brain was ejected out of the top of the right side of his head and actually arrived at the autopsy in a separate bucket."

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Paul's face was still intact, indicating that he was shot while slightly turned toward the shooter, she said.

Jurors were shown the gruesome photos of his injuries. Riemer added that Paul had no defensive wounds.

Diagram of the section of Alex Murdaugh's property where his wife, Maggie, and his son, Paul, were murdered. (WHD News )

Riemer next described Maggie's injuries. She sustained five gunshot wounds caused by at least four shots.

The first two struck her abdomen and thigh and left behind gunpowder stippling, indicating that the shooter was no more than three feet away.

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"We know she must have been in a lot of pain," Riemer testified. "She had projectiles, ammunition, going through her left kidney. You can imagine that was a painful wound and may have caused her to fold over."

Maggie likely collapsed on her knees with her hand over her belly and her head bent forward.

The next shot traveled in an upward trajectory through her chest, under her jaw and into her head. The shooter likely shot her from behind as she was bent over.

This shot likely caused the wound to her wrist, but Riemer couldn't say for sure. The shooter fired the final shot to the back of her head, which would have been immediately fatal.

It was fired in the opposite direction of the previous shot, suggesting the shooter had walked around Maggie and stood facing her. She also had no defensive wounds.

Murdaugh appeared deeply distressed, trembling and fidgeting with a yellow marker, during the disturbing testimony.

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A toxicology report indicated that Paul and Maggie had no alcohol or drugs in their systems – only caffeine.