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| | ==Microscopic evaluation== | | ==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.]]
| + | {{Main lung microscopic evaluation}} |
| − | 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>
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| − | *'''Edema and congestion''' (often together), indicating left sided heart failure:
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| − | :*'''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>
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| − | :*'''Chronic''' congestion manifests as thickened and fibrotic septa, and alveolar spaces containing numerous siderophages{{Siderophage note 2}}.<ref name=humpath/>
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| − | *'''Inflammatory''' cells, where a mild to moderate lymphocytic infiltrate is consistent with with heart failure, while neutrophils indicate pneumonia.
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| − | *'''Mycobacteria''' in regions of the world with substantial prevalence
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| − | *'''Carcinoma'''
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| − | *'''Aspiration''': Other foreign contents in airways. {{Further|Aspiration in autopsy}}
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| − | <gallery mode=packed heights=190>
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| − | File:Histopathology of pulmonary edema.jpg|'''Edema'''
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| − | File:Histopathology of bronchopneumonia.jpg|'''Bronchopneumonia''', with neutrophils filling a bronchiole.
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| − | File:Bronchioloalveolar Cell Adenocarcinoma of the Lung (4669552489).jpg|'''Carcinoma''' (in this case bronchioloalveolar cell adenocarcinoma)
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| − | </gallery>
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| − | | |
| | ''Additional potential findings are mentioned in the general '''[[Lungs]]''' article.'' | | ''Additional potential findings are mentioned in the general '''[[Lungs]]''' article.'' |
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Revision as of 11:33, 13 March 2020
Author:
Mikael Häggström [note 1]
Autopsy of the lungs, not including larger pulmonary vessels (instead summarized at Autopsy - Other thorax).
Basic autopsy cutting
In non-forensic Autopsy:
- 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.
- Make some additional sections through the lung parenchyma. Squeeze at each side to detect any pus and edema.[1]
Further information: Autopsy
Gross evaluation
Gross pathology of miliary "millet seed-like" tuberculosis.
- A spongy consistency, and watery and frothy liquid being pressed from the parenchyma, indicates simple edema.[2]
- A spongy consistency and reddish (blood-stained) fluid being pressed from the parenchyma, indicates acute congestion.[2]
- A brownish or dark reddish color of the fluid pressed from the parenchyma indicates chronic congestion, and may not have a spongy consistency.[2]
Fixation
Generally 10% neutral buffered formalin.
See also: General notes on fixation
Microscopic evaluation
Template:Main lung microscopic evaluation
Additional potential findings are mentioned in the general Lungs article.
Reporting
Report findings and if they are consistent with already known diagnoses.
Example:
| Presence of sideophages indicating chronic heart failure. Prominent vessels, including alveolar capillaries, and a moderate lymphocytic infiltrate, consistent with chronic heart failure or acute decompensation.
|
Further information: Autopsy
Notes
- ↑ 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.
Main page
References
- ↑ Burton, Julian L.; Rutty, Guy N. (2010). The Hospital Autopsy A Manual of Fundamental Autopsy Practice
(3rd ed.). Oxford University Press. ISBN 978-0340965146.
- ↑ 2.0 2.1 2.2 page 62 in: J. Martin Beattie (2014). Post-Mortem Methods
. Cambridge University Press. ISBN 9781107418004.
Image sources
