Difference between revisions of "Autopsy"

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There are many variants, with the following being a suggestion:
 
There are many variants, with the following being a suggestion:
 
{{Heart - standard autopsy cutting|coronary note= |header= ===Heart===}}  
 
{{Heart - standard autopsy cutting|coronary note= |header= ===Heart===}}  
 +
Look for signs of myocardial infarction. ''Further information: '''[[Autopsy of myocardial infarction]]''' ''
 +
 
===Other thorax===
 
===Other thorax===
 
*Dissect the '''aorta''', with an anterior approach to the aortic arch and major branches, and posterior approach to the descending thoracic aorta. Check for thrombosis and degree of atherosclerosis. Then separate the descending thoracic aorta from the esophagus.
 
*Dissect the '''aorta''', with an anterior approach to the aortic arch and major branches, and posterior approach to the descending thoracic aorta. Check for thrombosis and degree of atherosclerosis. Then separate the descending thoracic aorta from the esophagus.

Revision as of 10:58, 19 December 2019

Author: Mikael Häggström [note 1]

Comprehensiveness

Factors supporting a relatively more comprehensive autopsy and/or report, particularly in the inclusion of negated findings:

  • Lack of explanation from existing evidence. On the other hand, for example, upon finding an obvious aortic rupture, the rest of the autopsy is less relevant and may be relatively short.
  • Double-reading: If your report is likely to undergo double reading by another pathologist before sign-out, it needs to be more detailed, because the doctor who will do the double-reading then knows that you have looked at those locations.
  • Highly suspected locations, such as given from the referral.

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Basic checklist of non-forensic autopsy

There are many variants, with the following being a suggestion:

Heart

edit

  • Remove the parietal pericardium
  • Separate the heart from the from lungs by cutting through the major vessels. The pulmonary artery should be cut first and the lumen inspected for any pulmonary embolism.
  • Weigh the heart.
  • Dissect the coronary vessels.   Further information: Arteries
  • On the right side of the heart, dissect in the direction of blood flow: Superior vena cava > right atrium > tricuspid valve > right ventricle. Look for thromboses or patent foramen ovale.[note 2]
  • Dissect the atrial appendages, to exclude thromboses.
  • Dissect the left ventricle, such as into circumferential slices from the apex to the base.[note 3] Inspect (and measure) the left ventricular wall thickness.
Valve circumferences are measured at the basal ring (bottom in image).
  • (Measure the circumferences of the four valves. Cutoffs for valve dilatation:[1]
  • Mitral valve: circumference greater than 9.9 cm in males and 9.1 cm in females
  • Aortic valve: circumference greater than 8.5 cm in males and 7.9 cm in females
  • Tricuspid valve: circumference greater than 11.8 cm in males and 11.1 cm in females
  • Pulmonic valve: circumference greater than 7.5 cm in males and 7.4 cm in females)

Look for signs of myocardial infarction. Further information: Autopsy of myocardial infarction

Other thorax

  • Dissect the aorta, with an anterior approach to the aortic arch and major branches, and posterior approach to the descending thoracic aorta. Check for thrombosis and degree of atherosclerosis. Then separate the descending thoracic aorta from the esophagus.
Relations of the aorta, trachea, esophagus and other heart structures
  • Dissect the pulmonary arterial system, from the pulmonary trunk and including at least segmental arteries. To avoid cutting through the left main bronchus (passing anteriorly to the left main pulmonary artery), the initial dissection of the left main pulmonary artery may begin from an anterior perspective but keeping the cuts along the posterior wall, until the dissection can be seen and be continued from a posterior approach. Check the pulmonary arteries for thrombosis.
  • Esophagus: Distinguish from trachea and dissect
Blood clots[2]
Pre-mortem Post-mortem
Tumor embolus in the main pulmonary artery.jpg
Texture Dull Shiny
Wall adherence Yes No
Color Grey. Possibly zebraic appearance by lines of Zahn, with mixed red and grey/yellow Dark purple or bilayered yellow/red (by gravity sedimentation)
Pressurized Yes, can eject from lumen No, needs to be pulled-out
Consistency Firm and brittle Elastic, jellylike
  • Dissect the trachea and the bronchial tree, at least to segmental bronchi. Check for obstructions.
  • Make some additional sections through the lung parenchyma. Squeeze at each side to detect any pus and edema.[3]
  • Cut each thyroid lobe in horizontal slices and inspect the parenchyma.
  • Look for enlarged lymph nodes in the hilar and paratracheal area.

Retroperitoneal

For orientation, the coeliac trunk and mesenteric arteries exit the aorta from the anterior side.

  • Dissect the descending abdominal aorta. Cut external iliac artery from a dorsal approach, or after freeing ureters.[notes 1]
  • Dissect the renal arteries until entry into kidneys
  • Make a couple of cuts through the adrenal glands, such as transversal ones, and look mainly for tumors.
  • Cut the kidneys in the coronal planes. Clear each renal pelvis and follow the ureters to the bladder
  • Dissect the prostate and urinary bladder by an anterior approach. Dissect the ureteropelvic junctions.
  • Dissect the rectum

Peritoneal

  • Remove the diaphragm and excess omentum
  • Dissect the ventricle along the greater curvature, as well as the duodenum and the esophageal entry into the ventricle
  • Dissect the extrahepatic biliary tract: Identify the ampulla of Vater, possibly by bile flow when squeezing the gallbladder. Dissect the common bile duct, cystic duct and gallbladder.

Template:Gross processing of the liver

"Long" and "short" axis.[4]

Potential findings:

  • Make consecutive short axis slices through the spleen and pancreas[notes 2].

Brain

  • Inspect: Grooves indicating herniation? Hemorrhages?
  • Dissect the basilar artery and circle of Willis, either before or after separation from the brain. Look mainly for thromboses.
  • Separate the brainstem, cerebellum and cerebrum, which may be done by first separating the former two together from the cerebrum. Slice each part, looking for hemorrhages and/or infarcts.

Weighing

Separate and weigh these organs:

Tissue sampling

Any tissues where histopathology may aid in establishing the cause of death. If there is no clear cause of death macroscopically after an autopsy, take routine samples:

  • Heart
  • (Each lobe of) each lung
  • Liver
  • Each kidney

Reporting of non-forensic autopsy

Template

Annotations used in this example
[5]

<< Decision needed between alternatives separated by / signs >>
{{Common findings / In case of findings}}
[[Comments]]
Organs are in bold in this example for clarity, but does not need to be in an actual report.

(Where findings are made, general statements of clearing a region should still be given, such as: "There is a 18.0 cm curvilinear well-healed thin scar in the left thorax. Otherwise, there are no puncture marks or healed surgical scars on the torso.")

Data
  • Autopsy No.: ________
  • (Hospital No.:000046)
  • Patient name: Bloggs, Joe
  • (Patient No.:
  • (Ward :_______)
  • Age [[or birthdate]]: _____
  • (Sex: ______)
  • (Race: ______)
  • (Permission: From [[usually close relative of the patient]])
  • Date (and time) of death: ______
  • Date (and time) of autopsy: ______
  • (Date of report: _________)
  • Attending physician: _______
  • (Prosector:__________)
  • {{Limitation of the autopsy}} [[such as restriction to thorax only]].
Final autopsy diagnosis

[[List of pertinent findings, generally starting with the most relevant for the cause of death, and ending with less relevant and incidental findings. May be placed by the bottom of the report.]]

(Clinical history

_________)

(Laboratory data

_________)

External inspection

((The autopsy is performed approximately __ hours after death. The body is a ((well developed,)) << ((well nourished)) / {{underweight / overweight}}>> (__ year old [[if not already given in data]]) << woman / man >>. Lengths is __ cm and weight is __ kg.

Usual signs of death. (Rigor mortis is << well marked / broken >>. Lividity is seen on the << front / back and/or side >>.

(There are no puncture marks or healed surgical scars on the torso.)((There is no jaundice or peripheral edema. The head is not deformed. The sclerae, cornea and lenses are clear. The nose and external ears are unremarkable and their passages are clear. The lips and gums show no lesions and the patient is not edentulous. The neck structures are symmetrical, and there are no unusual masses. The thorax has normal contour and symmetry, and the male breasts and nipples are unremarkable. External abdominal palpation detects no abnormal masses or fluid waves. The testes are descended and without abnormal masses. No palpable inguinal masses. The extremities show no scars or deformities.))


Further text conversion needed from here:

INTERNAL INSPECTION

Template:Overall grave autolysis which complicates patomorfologisk assessment.

serous CAVITY No increased amount of fluid in pericardiet, pleural or cavitas abdominalis. Serous surfaces are smooth and lustrous.((No signs of inflammation. No adhesions))

circulatory organs heart << normal weight normal large / is enlarged [[> 399 g in women and> 449 g in but]] >>, On ___ g << and is normalkonfiguretat /{{. The left ventricle and septum {{}} is dilated / väggförtjockad}} No substantial förmaksdilatation seen. ((Left chamber and septum is normal {{}} thick at its thickest mm ___ Template:Concentric thickening and hay chamber is thickest ___ mm.)) ((Foramen ovale is closed.)) Coronarkärlen << has pronounced / moderate / mild / no >> Template:Places and calcified arteriosclerotic vägginlagringar, << with / without significant >> constrictions. No tornadoes in the heart or heart ears.

Cordae tendineae, endocardiet and heart valves clear. Cordae tendineae clear. Endocardium is smooth and shiny. The flaps are normal in number, and their mouths are thin and fine. No signs of inflammation. In the myocardium, no evidence of fresh lesion. No scar is seen. Myocardium has a homogeneous reddish brown when cut without secure postinfarktärr or signs of acute infarction.


In aortic and its major branches (Same, And Then :) The aorta larger ramifications ... be {{}} Widespread << pronounced / moderate / mild / no >> {{}} Places calcifiedarteriosclerotic vägginlagringar. No aneurysm. Renal arteries, no significant stenosis. No thrombus in the pulmonary arteries, pulmonary veins or vena cava.

RESPIRATORY TRACT

Larynx, trachea and bronchi are normally configured with irritant-free lining. Larynx is normalkonfigurerad. The vocal cords smooth and symmetrical. The trachea and the larger bronchi have irritant-free lining. No ulceration.

No foreign content viewed. ((Lungs with normal lobulering .. No tumor. No picture of inflammation macroscopically.))

lungs << have normal / increased >> w, __ g on the right and on the left __g. ((Consistency is normal Template:/ Easily increased.)) Cutting Surfaces are normally dark red, with no definable cures or bleeding. Template:Luftskummig liquid is pressed from the parenchyma, indicating pulmonary edema. Template:Multiple rib fractures, consistent with the HLR.

DIGESTIONSORGAN ((The tongue seen no bleeding.)) Esophagus, stomach and intestines are ordinary configured without tumors or blood in the lumen. The esophagus is normal thickness retningsfri mucosa. No diverticula or varices. The ventricle is of normal size, with normal content. << mucosa shows no signs of lesions/ Template:Mild / moderate erosions, but no ulceration.. Duodenum, jejunum and ileum and colon are ordinary configured with irritant-free lining. Content is normal. No visible tumor.Template:Appendix is oretad and normal large.

Template:Colonic diverticula seen without perforation.

The liver weighs ___g. The liver is << normal size/ Enlarged {{}}, On ___g. But: 970-1860 g. Women 600-1770g.

The surface is smooth. <<Normal/Template:/ Increased texture. The cut shows normal image. << normally homogeneous brown parenchyma / Template:Yellowish color, indicating steatosis / Template:Dark nutmeg similar paths, indicating stasis. No definable foci of cut.

gallbladder is regular size, thinwalled and contains Template:St concretions on upwardly mm. otherwisenormal bile. ((No tumor or {{}} concretions.))Mild cholesterolos {{.}} Bile ducts are open. Extrahepatic biliary tract is extraordinary and without calculi in the lumen. Pancreas normal large, With the ordinary form. The cut shows the normal picture((Without bleeding or definable hardens)).

Lymphoid and endocrine organs spleen is << normal large {{/ Enlarged [[> 230g]]}}, On ___ g.Template:Fixed texture suggestive of chronic venous stasisThe cut shows normal image. normal bluish-red color, with no definable foci of cut.


thyreoidea and adrenal glands bilaterally clear. Thyroid and adrenal glands are ordinary configured and no definable foci of cut.

No abnormal lymph nodes. Lymph nodes paratrakealt, paraaortalt and the abdomen is normal sized. Texture and color are normal.

((No definable curing of cut.))

urogenital kidneys is monosized normal sized with the total weight of ___ g.Fibrous capsule surrounding the kidney fired with ease. smooth surfaces/ Template:Grained surface, possibly indicating nephrosclerosis. On average surfaces have well-defined parenchyma pith and bark, with ordinary cartoon papillae.

renal Pelvis and ureters UA. Renal pelvis and ureters are normal wide with irritation-free mucosal and free lumens.


bladder is ordinary. normal size. The mucosa is normal. No tumor.

Either: • Man: The prostate is normal size((, Normal elastic texture and color),). No definable foci of cut. • Female: Uterus and adnexa shows a normal picture.


CNS The brain membranes and venous sinus clear. Dura and durasinus shows the normal picture. No tornadoes seen. No bleeding is seen subdural. Leptomeningierna are thin, shiny and irritant-free, with no visible bleeding.


The brain is symmetrical and weighs ___g. Cerebrum and cerebellum hemispheres are of equal size, and has a normal weight of ___g. But: 1.180 to 1.620 g Women: 1.030 to 1.400 g No photo of obstruction. No footprint devices seen on the large base of the brain or the cerebellum. No tumor, malaci or bleeding. Ordinary ventricular. ((Ventricles of the brain is widely normal, with normal siding.))

The tissue of the cerebrum, the cerebellumand brainstem shows normal subscription. On average surfaces seenOrdinary gray and white parenchyma, no bleeding ((, Definable cures or other lesion)). The basal cerebral arteries << are ordinary / Template:Has strong / moderate / call atherosclerotic vägginlagringar>> without aneurysms or thrombus.

SKELETON Calotte and skull base is ordinary. The dome and the base detected no lesions or injuries. ((Ua vertebral column.))

MICRO No samples taken / {{Tissue samples have to be taken from << heart, lungs, liver and / or kidneys >> Supplementary microscopic {{}} and bacteriological examination. ((Survey results will be reported separately.))}}


Diagnosis preliminary diagnosis Clinical diagnoses

Codes:


Notes

  1. Measures are taken to avoid cutting through the ureters.
  2. The pancreas may also be cut in the longitudinal plane.
  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. The right ventricle can alternatively be cut in circumferential slices along with the left ventricle.
  3. An alternative approach is to cut the left ventricle through a cut along the left lateral margin, followed by an anterior cut from the apex to the aortic root, freeing the anterior wall. Then cut through the plane of the myocardium of the anterior and posterior myocardial wall, as well as the septum, for any signs of infarction. (Dissect one or more papillary muscles for infarction.)

Main page

References

  1. Kitzman, Dalane W.; Scholz, David G.; Hagen, Philip T.; Ilstrup, Duane M.; Edwards, William D. (1988). "Age-Related Changes in Normal Human Hearts During the First 10 Decades of Life. Part II (Maturity): A Quantitative Anatomic Study of 765 Specimens From Subjects 20 to 99 Years Old ". Mayo Clinic Proceedings 63 (2): 137–146. doi:10.1016/S0025-6196(12)64946-5. ISSN 00256196. 
    • Griffith, Christopher C.; Raval, Jay S.; Nichols, Larry (2012). "Intravascular Talcosis due to Intravenous Drug Use Is an Underrecognized Cause of Pulmonary Hypertension
    ". Pulmonary Medicine 2012: 1–6. doi:10.1155/2012/617531. ISSN 2090-1836. 
  2. Michael Bonert. Autopsy. Page was last modified: 6 September 2016
  3. Burton, Julian L.; Rutty, Guy N. (2010). The Hospital Autopsy A Manual of Fundamental Autopsy Practice (3rd ed.). Oxford University Press. ISBN 978-0340965146. 
  4. Pellerito, John; Polak, Joseph F. (2012). Introduction to Vascular Ultrasonography (6th ed.). Elsevier Health Sciences. p. 559. ISBN 978-1-4557-3766-6. 
  5. The report is partially inspired from: Error on call to Template:cite web: Parameters url and title must be specified. . State University of New York Health Science Center at Syracuse, Department of pathology (1997-05-26).

Image sources