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Lung autopsy

3,199 bytes added, 21:54, 19 June 2022
*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>
*'''Weigh''' each lung.
:''For context, see '''[[Autopsy]]'''''
===Gross evaluation===
*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==
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]]. {{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 lung microscopic evaluationdiagnoses===*'''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.]]
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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