Heart autopsy: Difference between revisions
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{{Top | <noinclude>{{Top | ||
|author1=[[User:Mikael Häggström|Mikael Häggström]] | |author1=[[User:Mikael Häggström|Mikael Häggström]] | ||
|author2= | |author2= | ||
}} | }} | ||
'''[[Autopsy]]''' of the '''[[heart]]''': | '''[[Autopsy]]''' of the '''[[heart]]''': | ||
{{Autopsy - comprehensiveness}} | {{Autopsy - comprehensiveness|otherlegend=yes}}</noinclude> | ||
{{Heart - standard autopsy cutting|coronary note= ''More details in section below.''|header= | {{Heart - standard autopsy cutting|coronary note= ''More details in section below.''|header= | ||
==Autopsy cutting checklist== | ==Autopsy cutting checklist== | ||
}} | }} | ||
<gallery | In case of suspected infarction, see '''[[autopsy of myocardial infarction]]'''. | ||
File:Gross pathology of papillary muscle infarction.jpg|Circumferential slice of left ventricle, showing a fresh papillary muscle infarction. | |||
For left and right wall thickness, uppr limits of 1.5 cm and 0.5 cm, respectively, are generally used to distinguish wall thickening on autopsy.<ref name="Sant’Annade Mello2012">{{cite journal|last1=Sant’Anna|first1=Mirella Pessoa|last2=de Mello|first2=Roberto José Vieira|last3=Montenegro|first3=Luciano Tavares|last4=Araújo|first4=Mônica Modesto|title=Hipertrofia cardíaca esquerda e direita em necropsias de hipertensos|journal=Revista da Associação Médica Brasileira|volume=58|issue=1|year=2012|pages=41–47|issn=01044230|doi=10.1590/S0104-42302012000100013}}</ref><ref group=note>The limit is different from those measured in life by medical imaging, because the left ventricular thicknesses are generally 3-5 mm thicker at autopsy than during life. In comparison, the average thickness of the left ventricle is up to 8 mm in women and 9 mm in men on MRI, using the 95% prediction interval for the short axis images at the mid-cavity level.<br>- {{cite journal|last1=Kawel|first1=Nadine|last2=Turkbey|first2=Evrim B.|last3=Carr|first3=J. Jeffrey|last4=Eng|first4=John|last5=Gomes|first5=Antoinette S.|last6=Hundley|first6=W. Gregory|last7=Johnson|first7=Craig|last8=Masri|first8=Sofia C.|last9=Prince|first9=Martin R.|last10=van der Geest|first10=Rob J.|last11=Lima|first11=João A.C.|last12=Bluemke|first12=David A.|title=Normal Left Ventricular Myocardial Thickness for Middle-Aged and Older Subjects With Steady-State Free Precession Cardiac Magnetic Resonance|journal=Circulation: Cardiovascular Imaging|volume=5|issue=4|year=2012|pages=500–508|issn=1941-9651|doi=10.1161/CIRCIMAGING.112.973560}}</ref> | |||
<gallery heights=190 widths=350px> | |||
File:Gross pathology of papillary muscle infarction.jpg|Circumferential slice of left ventricle, showing a fresh papillary muscle '''infarction'''. | |||
File:Gross pathology of left ventricular hypertrophy.jpg|Concentric left ventricular hypertrophy. Left ventricle is at right in image, serially sectioned from apex to near base. | |||
</gallery> | </gallery> | ||
== | ==Gross examination of coronary arteries== | ||
[[File:Coronary vessels, with annotated arteries.svg|thumb]] | [[File:Coronary vessels, with annotated arteries.svg|thumb]] | ||
Make longitudinal | To find the right and left coronary arteries, look distally to each corresponding aortic valve cusp. | ||
*This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)</ref> | |||
Make longitudinal {{Moderate-begin}}(or transverse cuts at 3 mm intervals<ref name="MichaudBasso2019">{{cite journal|last1=Michaud|first1=Katarzyna|last2=Basso|first2=Cristina|last3=d’Amati|first3=Giulia|last4=Giordano|first4=Carla|last5=Kholová|first5=Ivana|last6=Preston|first6=Stephen D.|last7=Rizzo|first7=Stefania|last8=Sabatasso|first8=Sara|last9=Sheppard|first9=Mary N.|last10=Vink|first10=Aryan|last11=van der Wal|first11=Allard C.|title=Diagnosis of myocardial infarction at autopsy: AECVP reappraisal in the light of the current clinical classification|journal=Virchows Archiv|year=2019|issn=0945-6317|doi=10.1007/s00428-019-02662-1}} | |||
*This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)</ref>{{Moderate-end}} through: | |||
*The right coronary artery. | *The right coronary artery. | ||
* | *{{Comprehensive-begin}}The right marginal artery{{Comprehensive-end}} | ||
*The left coronary and circumflex artery. | *The left coronary and circumflex artery. | ||
*The left anterior descending artery. | *The left anterior descending artery. | ||
* | *{{Comprehensive-begin}}The left marginal artery{{Comprehensive-end}} | ||
* | *{{Comprehensive-begin}}The left diagonal branch{{Comprehensive-end}} | ||
* | *{{Finding-begin}}Any vessel grafts to the heart{{Finding-end}} | ||
Examine for atherosclerosis, stenosis and thrombi | |||
Estimate the percentage of any significant stenosis or occlusion. | {{Moderate-begin}}If the coronary arteries are calcified, sharply dissect them from the heart, without cutting too deeply into the muscle. Fix them in formalin, decalcify them and then cut them at 3 mm intervals.{{Moderate-end}} | ||
<gallery mode=packed> | |||
Estimate the percentage of any significant stenosis or occlusion. {{Further|Arteries|linebreak=no}} | |||
<gallery mode=packed heights=200> | |||
File:Plaque at different degrees of atherosclerotic stenosis.jpg|Plaque at different percentages of atherosclerotic stenosis.<ref name="MichaudBasso2019"/> | File:Plaque at different degrees of atherosclerotic stenosis.jpg|Plaque at different percentages of atherosclerotic stenosis.<ref name="MichaudBasso2019"/> | ||
</gallery> | </gallery> | ||
The presence of a totally occlusive thrombotic mass confers a diagnosis of likely sudden cardiac death death even in the absence of microscopically visible necrosis.<ref name="MichaudBasso2019"/> | The presence of a totally occlusive thrombotic mass confers a diagnosis of likely sudden cardiac death death even in the absence of microscopically visible necrosis.<ref name="MichaudBasso2019"/> | ||
==Myocardium== | ==Weight== | ||
Cardiomegaly can be defined as a weight exceeding the 95th percentile of normal individuals, preferably adjusted for weight, size, age and gender.<ref>{{cite web|url=https://labs.feinberg.northwestern.edu/webster/heart_weight/|title=Chicago model for post-mortem classification of cardiomegaly|website=Northwestern University Feinberg School of Medicine|accessdate=2020-01-15}}</ref><ref name=chicago group=note>External link: [https://labs.feinberg.northwestern.edu/webster/heart_weight/ Chicago model for post-mortem classification of cardiomegaly], adjusted for weight, size, age and gender.</ref> | |||
[[File:Weight of heart versus body.jpg|thumb|center|300px|Weight of heart versus body.<ref name="KumarLiestøl2014">{{cite journal|last1=Kumar|first1=Neena Theresa|last2=Liestøl|first2=Knut|last3=Løberg|first3=Else Marit|last4=Reims|first4=Henrik Mikael|last5=Mæhlen|first5=Jan|title=Postmortem heart weight: relation to body size and effects of cardiovascular disease and cancer|journal=Cardiovascular Pathology|volume=23|issue=1|year=2014|pages=5–11|issn=10548807|doi=10.1016/j.carpath.2013.09.001}}</ref><ref name=chicago group=note/>]] | |||
==Microscopic examination== | |||
===Myocardium=== | |||
Look for: | Look for: | ||
*Signs of myocardial infarction: | *Signs of myocardial infarction<noinclude>: | ||
<gallery> | <gallery mode=packed heights=200> | ||
File:Histopathology of myofiber waviness in myocardial infarction.jpg|Streched/wavy fibres | File:Histopathology of myofiber waviness in myocardial infarction.jpg|Streched/wavy fibres | ||
File:Histopathology of hypereosinophilia and coagulative necrosis of cardiomyocytes.jpg|Coagulative necrosis: ‘hypereosinophilia’ | File:Histopathology of hypereosinophilia and coagulative necrosis of cardiomyocytes.jpg|Coagulative necrosis: ‘hypereosinophilia’ | ||
| Line 41: | Line 56: | ||
File:Histopathology of granulation tissue with formation of microvessels in myocardial infarction.jpg|Vessel/endothelial sprouts | File:Histopathology of granulation tissue with formation of microvessels in myocardial infarction.jpg|Vessel/endothelial sprouts | ||
File:Histopathology of fibroblast proliferation and early collagen deposition in myocardial infarction.jpg|Fibroblast and young collagen | File:Histopathology of fibroblast proliferation and early collagen deposition in myocardial infarction.jpg|Fibroblast and young collagen | ||
File:Histopathology of dense fibrous scar replacing myocyte loss in myocardial infarction.jpg| | File:Histopathology of dense fibrous scar replacing myocyte loss in myocardial infarction.jpg|Fibrosis. {{further|Myocardial fibrosis|linebreak=no}} | ||
</gallery></noinclude> | |||
If one or more is present, see '''[[Autopsy of myocardial infarction]]''' | |||
*{{Moderate-begin}}Optionally, also look for:{{Moderate-end}} | |||
<gallery mode=packed heights=200>> | |||
File:Histopathology of ruptured intercalated discs.jpg|Ruptured intercalated discs. {{Further|Ruptured intercalated discs|linebreak=no}} | |||
File:Histopathology of mitral valve with myxomatous degeneration, annotated.jpg|Myxomatous degeneration of valves. | |||
</gallery> | </gallery> | ||
*{{Moderate-begin}}Optionally, also perform a '''[[Heart#Basic_microscopic_screening|General microscopic screening]]'''.{{Moderate-end}} | |||
==Reporting== | ==Reporting== | ||
This is en example report: | |||
{{Heart autopsy report}} | {{Heart autopsy report}} | ||
{{Reporting}} | {{Reporting}} | ||
{{Bottom}} | {{Bottom}} | ||