Multiple organ dysfunction, either from infectious or noninfectious causes, has been increasing in incidence in hospitals in developed countries and is present in an increasing proportion of hospital-based autopsies. It is the most common cause of death in noncoronary critical care units in Europe and the United States. This is largely enabled by increased use of critical care supportive measures, particularly in high-risk and elderly populations.…

The occurrence of sudden death presents a challenge to the general autopsy pathologist, who usually examines hospitalized patients with detailed medical records. In this chapter we discuss the approach to the patient who dies within 1 hour of the onset of symptoms, an arbitrary definition of “sudden.” This group may be subdivided into the patients for whom death can be considered an expected outcome of a…

The autopsy report is a description and interpretation of the findings at necropsy and provides a record of the completed case as seen from the perspective of the anatomic pathologist. The document is part of the patient's medical record or, in the case of a fetus, the mother's medical record. As such, it is confidential; in accordance with the institution's regulations for medical records, the information…

Collection of Samples The hospital autopsy pathologist should take full advantage of modern chemical, microbiologic, cytogenetic, and molecular analysis of body fluids, tissues, and cells as a supplement to anatomic dissection and microscopic examination if necessary. Careful review of the case records usually indicates to the prosector whether special studies are needed. In most instances, the collection and proper storage of samples for such studies requires…

This chapter will present common or important microscopic findings seen in autopsies, with an emphasis on deaths that are from natural causes or are hospital based. It is not meant to be comprehensive, but it should provide a helpful adjunct to the techniques outlined in earlier chapters and to the gross findings shown in Chapter 16 , the atlas portion of this book. We will not…

Brightfield Microscopy Brightfield or light microscopic analysis of organs and tissues supplements the gross autopsy examination and is an integral part of a complete postmortem examination. Although the focus and extent of the microscopic examination vary from case to case, microscopy of diseased tissues often aids the pathologist in correlating pathologic abnormalities with clinical findings. For the pathologist in training, microscopic examination of tissues obtained at…

Autopsy Photography The benefits of autopsy photographs have increased greatly with digital photography, and gross photographs can be important parts of autopsy reports, clinical con­ferences, consultation, teaching, and research. Digital cameras are quite easy to use and, with a moderate amount of attention to sample preparation, composition, and camera settings, produce excellent gross photographs. Additionally, digital photographs are easy to share and display, but with this…

The thorough standard postmortem examination (described in Chapters 4 and 5 ) provides the framework for accurately detecting and diagnosing most clinical disease. However, the skillful autopsy pathologist, recognizing the limitations of the basic examination, supplements it with special dissections whenever indicated and possible. This chapter describes a number of useful techniques that broaden the basic autopsy. Special Examinations of the Heart Dissection of Hearts with…

The autopsy of the fetus, infant, or young child should be approached somewhat differently from that of the adult. At these early developmental stages, the presence of malformations is often the major consideration, and the dissection should be made to preserve anatomic relationships in order to define the abnormal anatomy. Thus organs are usually left together en bloc. This does not mean that there is less…

This chapter describes and illustrates systematic dissection sequences and procedures. Although developing a systematic approach to autopsy dissection and organ examination is efficient and generally desirable, the pathologist must be prepared to alter the examination as required for the best demonstration and diagnosis of specific diseases. A given method may be adequate for revealing the pathologic findings of one disease or condition; however, it may be…

During the course of work, the autopsy pathologist and staff members encounter a number of potential biohazards. By adhering to strict safety precautions, practicing proper autopsy technique, and using proper instruments and equipment, the pathologist can limit the risk of injury to individuals working at the autopsy table. This chapter provides an overview of important autopsy biosafety recommendations for usual hospital-based practice. Many points cannot be…

Autopsy Authorization The laws pertaining to authorization for autopsy vary among the states. Local jurisdictions may establish policies or procedures for compliance, and it behooves the practicing pathologist to know the relevant statutes in his or her region. In the United States, statutes pertaining to human remains stem from Old English common law. Thus, at death, possession or custody of the remains passes to a surviving…

The quotation above (Latin for “the dead teach the living”) historically has been cited either literally, as justification for examination of cadavers to learn anatomy and investigate pathology, or figuratively, to indicate learning from the work of past scholars. This chapter will present the history and past contributions of postmortem examination and will discuss the current objectives of autopsies, focusing especially on nonforensic autopsies. The Autopsy…