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Lung autopsy

1,755 bytes added, 19 June
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Not '''[[Autopsy]]''' of the '''[[lungs]]''', not including larger pulmonary vessels (instead summarized at [[Autopsy#Other_thorax|Autopsy - Other thorax]]).
==Basic autopsy cutting==
In non-forensic '''[[Autopsy]]''':
:The lungs may be cut after removing the heart through cutting through the major vessels close to it, or by removing each lung by cuts by each lung hilum.
 
*Dissect the '''pulmonary arterial system''', from the pulmonary trunk and including at least segmental arteries.
*Dissect the '''bronchial tree''', at least to segmental bronchi. Check for obstructions.
*'''Weigh''' each lung (possibly first if having cut each lung at the hilus).
*Make some additional sections through the '''lung parenchyma'''. Squeeze at each side to detect any pus and edema.<ref>{{cite book |author=Burton, Julian L.; Rutty, Guy N. |title=The Hospital Autopsy A Manual of Fundamental Autopsy Practice |publisher=Oxford University Press |location= |year=2010 |pages= {{{1|}}} |edition=3rd |isbn=978-0340965146 |oclc= |doi= |accessdate=}}</ref>
{{further|:''For context, see '''[[Autopsy}}]]'''''
===Gross evaluation===
[[File:Gross pathology of miliary tuberculosis of the lung.jpg|thumb|200px|Gross pathology of miliary "millet seed-like" tuberculosis.]]
*A spongy consistency and reddish (blood-stained) fluid being pressed from the parenchyma, indicates acute congestion.<ref name=Beattie2014/>
*A brownish or dark reddish color of the fluid pressed from the parenchyma indicates chronic congestion, and may not have a spongy consistency.<ref name=Beattie2014/>
 
Normal weight:
{|class=wikitable
! !! Left !! Right
|-
! Men<ref name="MolinaDiMaio2012">{{MolinaDiMaio2012}}</ref>
| 112-675g || 155-720g
|-
! Women<ref name="MolinaDiMaio2015">{{MolinaDiMaio2015}}</ref>
| 105-515g || 101-589g
|}
 
{{Fixation - standard}}
{{Fixation - general notes}}
==Microscopic evaluation==
[[File:Histopathology of pulmonary congestion and siderophages.jpg|thumb|220px|'''Siderophages'''{{Siderophage note 1}} (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:<ref name="TiwanaNibhoria2014">'''India''': {{cite journal|last1=Tiwana|first1=Kanwardeep Kaur|last2=Nibhoria|first2=Sarita|last3=Gupta|first3=Manvi|last4=Yadav|first4=Ashish|title=Histopathological Spectrum in Lung Autopsies- A 50 Case Study|journal=Indian Journal of Forensic Medicine & Toxicology|volume=8|issue=2|year=2014|pages=172|issn=0973-9122|doi=10.5958/0973-9130.2014.00709.9}}</ref><ref>'''United States''': {{cite web|url=https://washingtonforensicsservices.com/pulmonary-lung-conditions-found-at-autopsy/|title=Pulmonary Lung Conditions Found at Autopsy|author=Dr. Stanley Adams|website=Washington Forensic Services|accessdate=2019-12-20}}</ref>
*'''Edema and congestion''' (often together), indicating left sided heart failure::*'''Acute[[Alveolar fluid]]''' congestion manifests as alveolar capillaries being engorged with blood, as well as associated alveolar septal edema and/or focal intra-alveolar hemorrhage.<ref name=humpath>{{cite webfurther|url=http://humpath.com/spip.php?article7894|title=CongestionAlveolar fluid|websitelinebreak=Humpath|date=2005-12-19no}}</ref>:*'''ChronicVascular congestion''' congestion manifests as thickened and fibrotic septa, and which can usually be seen easiest in the alveolar walls. It indicates left sided heart failure, especially when seen together with [[alveolar spaces containing numerous siderophagesfluid]]. {{Siderophage note 2further|Chronic pulmonary congestion|linebreak=no}}.<ref name=humpath/>*'''Inflammatory''' cells, where a mild to moderate lymphocytic infiltrate is consistent with with heart failure, while neutrophils indicate pneumonia. '''[[pigmented macrophages of the lung]]''' may indicate chronic heart failure.
*'''Mycobacteria''' in regions of the world with substantial prevalence
*'''Carcinoma'''{{further|Lung tumor|linebreak=no}}
*'''Aspiration''': Other foreign contents in airways. {{Further|Aspiration in autopsy}}
*'''EmphysemaEmbolism'''of pulmonary arteries.
<gallery mode=packed heights=190>
File:Histopathology of pulmonary edema.jpg|'''Edema'''
File:Histopathology of bronchopneumonia.jpg|'''Bronchopneumonia''', with neutrophils filling a bronchiole.
File:Bronchioloalveolar Cell Adenocarcinoma of the Lung (4669552489).jpg|'''Carcinoma''' (in this case bronchioloalveolar cell adenocarcinoma){{further|Lung tumor|linebreak=no}}File:Histopathology of emphysemadiffuse alveolar damage.jpg|'''Emphysemahyaline membranes''', suggesting '' 'diffuse alveolar damage'''.File:Histopathology of a pulmonary artery with fat embolism and a bone marrow fragment.jpg|A pulmonary artery with fat embolism (enlarged alveoliseen as multiple empty globular spaces on this H&E stain since its processing dissolves fat). There is a bone marrow fragment in the middle, and multiple single hematopoietic cells in the blood, being evidence of fracture as the source of the embolism.
</gallery>
 
===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.<ref name=humpath>{{cite web|url=http://humpath.com/spip.php?article7894|title=Congestion|website=Humpath|date=2005-12-19}}</ref>
:*[[Chronic pulmonary congestion|'''Chronic''' pulmonary congestion]] manifests as thickened and fibrotic septa, and alveolar spaces containing numerous '''[[pigmented lung macrophages]]'''.<ref name=humpath/>
 
[[File:Histopathology of respiratory epithelial shedding.jpg|thumb|center|290px|If respiratory '''epithelial shedding''' is seen, look for vascular leakage, mucus hypersecretion and/or widespread airway narrowing, together indicating asthma death.<ref>{{cite book | last=Madea | first=B | title=Handbook of forensic medicine | publisher=Wiley-Blackwell | publication-place=Hoboken, N.J | year=2014 | isbn=978-1-118-57062-3 | oclc=872114659 | ref=harv}}</ref> Otherwise, it is a frequent postmortem change.]]
 
''Additional potential findings are mentioned in the general '''[[Lungs]]''' article.''
===Reporting===
Example:
{|class="wikitable"
| [[File:Histopathology of pulmonary congestion and siderophages.jpg|190px|left]] Presence of sideophages [[sideophage]]s indicating chronic heart failure. Prominent vessels, including alveolar capillaries, and a moderate lymphocytic infiltrate, consistent with chronic heart failure or acute decompensation.
|}
{{Further|Autopsy}}
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