Difference between revisions of "Lung autopsy"
Jump to navigation
Jump to search
(→Basic autopsy cutting: Possibly first) |
(→Microscopic evaluation: Moved from template) |
||
| Line 24: | Line 24: | ||
==Microscopic evaluation== | ==Microscopic evaluation== | ||
| − | {{Main | + | [[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> | ||
| + | *'''[[Alveolar fluid]]'''. {{further|Alveolar fluid|linebreak=no}} | ||
| + | *'''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|Lung tumor|linebreak=no}} | ||
| + | *'''Aspiration''': Other foreign contents in airways. {{Further|Aspiration in autopsy}} | ||
| + | <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}} | ||
| + | </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''' congestion manifests as thickened and fibrotic septa, and alveolar spaces containing numerous siderophages{{Siderophage note 2}}.<ref name=humpath/> | ||
| + | |}<noinclude> | ||
[[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.]] | [[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.]] | ||
Revision as of 09:40, 2 December 2020
Author:
Mikael Häggström [note 1]
Autopsy of the lungs, not including larger pulmonary vessels (instead summarized at Autopsy - Other thorax).
Contents
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.[1]
- For context, see Autopsy
Gross evaluation
- 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
Siderophages[notes 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:[3][4]
- 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
Edema
Bronchopneumonia, with neutrophils filling a bronchiole.
Carcinoma (in this case bronchioloalveolar cell adenocarcinoma) Further information: Lung tumor
Main diagnoses
- Left sided heart failure:
|}
If respiratory epithelial shedding is seen, look for vascular leakage, mucus hypersecretion and/or widespread airway narrowing, together indicating asthma death.[6] Otherwise, it is a frequent postmortem change.
Additional potential findings are mentioned in the general Lungs article.
Reporting
Report findings and if they are consistent with already known diagnoses.
Example:
|
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.
- ↑ 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:. ISSN 0973-9122.
- ↑ United States: Dr. Stanley Adams. Pulmonary Lung Conditions Found at Autopsy. Washington Forensic Services. Retrieved on 2019-12-20.
- ↑ 5.0 5.1 . Congestion. Humpath (2005-12-19).
- ↑ Madea, B (2014). Handbook of forensic medicine . Hoboken, N.J: Wiley-Blackwell. ISBN 978-1-118-57062-3. OCLC 872114659.
Image sources
