Difference between revisions of "Lung autopsy"
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| − | + | '''[[Autopsy]]''' of the '''[[lungs]]''', not including larger pulmonary vessels (instead summarized at [[Autopsy#Other_thorax|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.<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> | ||
| + | :''For context, see '''[[Autopsy]]''''' | ||
| + | ===Gross evaluation=== | ||
| + | [[File:Gross pathology of miliary tuberculosis of the lung.jpg|thumb|200px|Gross pathology of miliary "millet seed-like" tuberculosis.]] | ||
| + | |||
| + | *A spongy consistency, and watery and frothy liquid being pressed from the parenchyma, indicates simple edema.<ref name=Beattie2014>[https://books.google.se/books?id=VIbRAwAAQBAJ&pg=PA62 page 62] in: {{cite book|title=Post-Mortem Methods|author=J. Martin Beattie|publisher=Cambridge University Press|year=2014|isbn=9781107418004}}</ref> | ||
| + | *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== | ==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}} | |
| − | *Carcinoma | + | *'''Aspiration''': Other foreign contents in airways. {{Further|Aspiration in autopsy}} |
| − | <gallery> | + | *'''Embolism''' of pulmonary arteries. |
| − | File:Histopathology of pulmonary edema.jpg|Edema | + | <gallery mode=packed heights=190> |
| − | File: | + | 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> | </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 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.]] | ||
| + | |||
| + | ''Additional potential findings are mentioned in the general '''[[Lungs]]''' article.'' | ||
| + | |||
| + | ===Reporting=== | ||
| + | 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}} | ||
{{Bottom}} | {{Bottom}} | ||
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).
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]
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.
Edema
Bronchopneumonia, with neutrophils filling a bronchiole.
Carcinoma (in this case bronchioloalveolar cell adenocarcinoma) Further information: Lung tumor
hyaline membranes, suggesting diffuse alveolar damage.
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.
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:
 |
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.
- ↑ 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:. ISSN 0195-7910.
- ↑ 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:. ISSN 0195-7910.
- ↑ 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.
- ↑ 7.0 7.1 . 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
