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Author: Mikael Häggström [notes 1]

Tissue sampling


Generally 10% neutral buffered formalin.


Basic microscopic screening

Siderophages[notes 2] (one indicated by white arrow), indicating chronic left heart failure. Also pulmonary congestion and lymphocytes, consistent with acute or chronic heart failure.

Look for the most common pathologic lung findings:[1][2]

  • Alveolar fluid. Further information: Alveolar fluid
  • Vascular congestion, which can usually be seen easiest in the alveolar walls. It indicates left sided heart failure, especially when seen together with alveolar fluid.
  • Inflammatory cells, where a mild to moderate lymphocytic infiltrate is consistent with with heart failure, while neutrophils indicate pneumonia.
  • Mycobacteria in regions of the world with substantial prevalence
  • Carcinoma Further information: Lung tumor
  • Aspiration: Other foreign contents in airways.
Further information: Aspiration in autopsy

Main diagnoses

  • Left sided heart failure:
  • Acute congestion manifests as alveolar capillaries being engorged with blood, as well as associated alveolar septal edema and/or focal intra-alveolar hemorrhage.[3]
  • Chronic congestion manifests as thickened and fibrotic septa, and alveolar spaces containing numerous siderophages[notes 2].[3]

Other common findings

Active searching for them is not mandatory.


  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. 2.0 2.1 Objectively, siderophage-like cells would be reported as "brown pigment-containing macrophages", but can be presumed to be siderophages in this context.

Main page


  1. India: Tiwana, Kanwardeep Kaur; Nibhoria, Sarita; Gupta, Manvi; Yadav, Ashish (2014). "Histopathological Spectrum in Lung Autopsies- A 50 Case Study ". Indian Journal of Forensic Medicine & Toxicology 8 (2): 172. doi:10.5958/0973-9130.2014.00709.9. ISSN 0973-9122. 
  2. United States: Dr. Stanley Adams. Pulmonary Lung Conditions Found at Autopsy. Washington Forensic Services. Retrieved on 2019-12-20.
  3. 3.0 3.1 . Congestion. Humpath (2005-12-19).
  4. Madea, B (2014). Handbook of forensic medicine . Hoboken, N.J: Wiley-Blackwell. ISBN 978-1-118-57062-3. OCLC 872114659.