Lung autopsy

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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]


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]

  • Edema and congestion (often together), indicating 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.[5]
  • Chronic congestion manifests as thickened and fibrotic septa, and alveolar spaces containing numerous siderophages[notes 1].[5]
  • 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
  • Aspiration: Other foreign contents in airways. Further information: Aspiration in autopsy

Additional potential findings are mentioned in the general Lungs article.


Report findings and if they are consistent with already known diagnoses.


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


  1. 1.0 1.1 Objectively, siderophage-like cells would be reported as "brown pigment-containing macrophages", but can be presumed to be siderophages in this context.
  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


  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. 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. 
  4. United States: Dr. Stanley Adams. Pulmonary Lung Conditions Found at Autopsy. Washington Forensic Services. Retrieved on 2019-12-20.
  5. 5.0 5.1 . Congestion. Humpath (2005-12-19).

Image sources