Difference between revisions of "Lung autopsy"

From patholines.org
Jump to navigation Jump to search
 
(31 intermediate revisions by the same user not shown)
Line 3: Line 3:
 
|author2=
 
|author2=
 
}}
 
}}
Not including larger pulmonary vessels (instead summarized at [[Autopsy#Other_thorax|Autopsy - Other thorax]]).
+
'''[[Autopsy]]''' of the '''[[lungs]]''', not including larger pulmonary vessels (instead summarized at [[Autopsy#Other_thorax|Autopsy - Other thorax]]).
  
 
==Basic autopsy cutting==
 
==Basic autopsy cutting==
 
In non-forensic '''[[Autopsy]]''':
 
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 '''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.
 
*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>
 
*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|Autopsy}}
+
:''For context, see '''[[Autopsy]]'''''
 
===Gross evaluation===
 
===Gross evaluation===
 
[[File:Gross pathology of miliary tuberculosis of the lung.jpg|thumb|200px|Gross pathology of miliary "millet seed-like" tuberculosis.]]
 
[[File:Gross pathology of miliary tuberculosis of the lung.jpg|thumb|200px|Gross pathology of miliary "millet seed-like" tuberculosis.]]
Line 17: Line 20:
 
*A spongy consistency and reddish (blood-stained) fluid being pressed from the parenchyma, indicates acute congestion.<ref name=Beattie2014/>
 
*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/>
 
*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 - standard}}
 
{{Fixation - general notes}}
 
{{Fixation - general notes}}
  
 
==Microscopic evaluation==
 
==Microscopic evaluation==
[[File:Histopathology of pulmonary congestion and siderophages.jpg|thumb|220px|Siderophages (one indicated by white arrow), indicating chronic left heart failure. Also pulmonary congestion and lymphocytes, consistent with 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>
 
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:
+
*'''[[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]]. {{further|Chronic pulmonary congestion|linebreak=no}}
 +
*'''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}}
 +
*'''Embolism''' 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 diffuse alveolar damage.jpg|'''hyaline 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 (seen 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>
 
:*'''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.<ref name=humpath/>
+
:*[[Chronic pulmonary congestion|'''Chronic''' pulmonary congestion]] manifests as thickened and fibrotic septa, and alveolar spaces containing numerous '''[[pigmented lung macrophages]]'''.<ref name=humpath/>
*'''Pneumonia''': Inflammatory cells
+
 
*'''Tuberculosis''' in regions of the world with substantial prevalence
+
[[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.]]
*'''Carcinoma'''
+
 
*'''Aspiration''': Other foreign contents in airways.
+
''Additional potential findings are mentioned in the general '''[[Lungs]]''' article.''
<gallery>
 
File:Histopathology of pulmonary edema.jpg|Edema
 
File:Histopathology of bronchopneumonia.jpg|Bronchopneumonia, with neutrophils filling a bronchiole.
 
</gallery>
 
  
==Reporting==
+
===Reporting===
 
Report findings and if they are consistent with already known diagnoses.
 
Report findings and if they are consistent with already known diagnoses.
 +
 +
Example:
 +
{|class="wikitable"
 +
| [[File:Histopathology of pulmonary congestion and siderophages.jpg|190px|left]] Presence of [[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}}
 
{{Further|Autopsy}}
 
{{Bottom}}
 
{{Bottom}}

Latest revision as of 21:54, 19 June 2022

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:

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

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]

Normal weight:

Left Right
Men[3] 112-675g 155-720g
Women[4] 105-515g 101-589g

Fixation

Generally 10% neutral buffered formalin.

  See also: General notes on fixation


Microscopic evaluation

Look for the most common pathologic lung findings:[5][6]

  • 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. Further information: Chronic pulmonary congestion
  • 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 information: Lung tumor
  • Aspiration: Other foreign contents in airways. Further information: Aspiration in autopsy
  • Embolism of pulmonary arteries.

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.[7]
  • Chronic pulmonary congestion manifests as thickened and fibrotic septa, and alveolar spaces containing numerous pigmented lung macrophages.[7]
If respiratory epithelial shedding is seen, look for vascular leakage, mucus hypersecretion and/or widespread airway narrowing, together indicating asthma death.[8] 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:

Histopathology of pulmonary congestion and siderophages.jpg
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

  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.

Main page

References

  1. 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. 2.0 2.1 2.2 page 62 in: J. Martin Beattie (2014). Post-Mortem Methods . Cambridge University Press. ISBN 9781107418004. 
  3. Standard reference range: Molina, D. Kimberley; DiMaio, Vincent J.M. (2012). "Normal Organ Weights in Men ". The American Journal of Forensic Medicine and Pathology 33 (4): 368–372. doi:10.1097/PAF.0b013e31823d29ad. ISSN 0195-7910. 
  4. Standard reference range: Molina, D. Kimberley; DiMaio, Vincent J. M. (2015). "Normal Organ Weights in Women ". The American Journal of Forensic Medicine and Pathology 36 (3): 182–187. doi:10.1097/PAF.0000000000000175. ISSN 0195-7910. 
  5. 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. 
  6. United States: Dr. Stanley Adams. Pulmonary Lung Conditions Found at Autopsy. Washington Forensic Services. Retrieved on 2019-12-20.
  7. 7.0 7.1 . Congestion. Humpath (2005-12-19).
  8. Madea, B (2014). Handbook of forensic medicine . Hoboken, N.J: Wiley-Blackwell. ISBN 978-1-118-57062-3. OCLC 872114659. 

Image sources