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Espiratory System Autopsy
Espiratory System Autopsy
AUTOPSY
INTRODUCTION
Lungs are a pair of respiratory organs situated in
the thoracic cavity
Covered by the parietal pleura and visceral
pleura
spongy texture
Base
RIGHT LUNG
2 bronchi – eparterial and hyparterial
One pulmonary artery between the bronchi
Dr.D.Gomathinayagam, M.D.,
NORMAL LUNG: PLEURAL SURFACE
Dr.
D.G
oma
thin
aya
gam
,
M.D.
ABNORMALITIES OF PLEURAL
CAVITY
PNEUMOTHOR
AX
Complication of pulmonary
diseases ( emphysema, TB,
asthma)
Spontaneous idiopathic
Trauma
DIAGNOSIS
Fill the space between ribs
and thoracic skin flap with
water and look for escape
of air bubbles while
incising the 1 st IC space.
EFFUSIONS WITHOUT PLEURITIS
Clear straw coloured
HEMOTHORAX
serous ( hydrothorax )
clear straw coloured serous
(hydothorax)– CCF
Frank blood ( hemothorax
) – ruptured aortic
aneurysm, cardiac rupture,
thoracic trauma
Milky white chyle (
chylothorax ) –
obstruction by
malignancies
HEMOTHORAX
Dr.
D.G
oma
thin
aya
gam
,
M.D.
CHYLOTHORAX
Dr.
D.G
oma
thin
aya
gam
,
M.D.
EFFUSIONS WITH PLEURITIS
Dr.
D.G
oma
thin
aya
gam
,
M.D.
SEROFIBRINOUS
EMPYEMA PLEURITIS
MASSES
Solid with whorled
appearance ,
occasional cyst – SFT
Soft gelatinous
greyish pink tumour
tissue – malignant
mesothelioma
Variable nodularity –
metastasis.
MESOTHELIOMA
Dr.
D.G
oma
thin
aya
gam
,
M.D.
LARNYX, TRACHEA & BRONCHI
After removal of chest organs, larynx, trachea
and both bronchi are opened along their posterior
walls and inspect mucosa.
CONGENITAL ANOMALIES
AGENESIS
HYPOPLASIA
HETEROTOPIC
TISSUE
VASCULAR
ANOMALIE
TRACHEAL AND
BRONCHIAL
ANOMALIES
CONGENITAL CYSTS
BRONCHOPULMON
ARY
SEQUESTRATION
ABNORMALITIES OF LARYNX
Edema of glottis – mucosa swollen
Pseudomembranous inflammation – fibrinous
exudate removed without leaving ulcer
Diphtheritic or necrotising inflammation –
necrosis with fibrinous membrane, removal yields
bloody ulcer
Laryngotracheobronchitis – mucosa hyperemic
and edematous, young children
TB – small nodules, shallow ulcer with undermined
margins
Syphilis – gummatous ulcers, large stellate scars
Tumours – benign polyps, papilloma, fibroma.
Malignant primary or secondary
PAPILLOMA
SCC LARYNX
LARYNX
ABNORMALITIES OF TRACHEA
Congenital anamolies – tracheoesophageal
fistula , branchial fistula
Tracheitis – red and edematous
Occasionally FB occurs
ASTHMA:INFLATED EXTRA
Dr.
D.G
oma
thin
aya
gam
,
M.D.
Bronchiectasis –
dilated airways ( 4 times
) that reach pleural
surface, filled with pus
Types
Diffuse – CF, ciliary
dyskinesia,
immunodeficiency states
Localised – post
infection ( TB,
suppurative
pneumonias, measles)
BRONCHIECTASIS
Dr.
D.G
oma
thin
aya
gam
,
M.D.
EXAMINATION OF LUNGS
Lungs removed by cutting bronchi close to carina
and root structures as far away from hilus as
possible
Left lung removed first
opened.
WET FIXATION OF LUNGS
Generally one lung dissected fresh other formalin
fixed
Dr.
D.G
oma
thin
aya
gam
,
M.D.
EMPHYSEMATOUS BULLAE
Edema of lungs – enlarged, heavy firm, . c/s –
large amount of red foamy liquid.
Dr.
D.G
oma
thin
aya
gam
,
M.D.
PULMONARY EMBOLISM
Dr.
D.G
oma
thin
aya
gam
,
M.D.
Fat emboli
Follows fracture of long bones, operations in fatty
tissues
Pulmonary A opened under water and watched for
escape of fat droplets
Air emboli
Follows injections of air into body, operations(
laproscopic ) , cutting of large veins, decompression
sickness/ caisson disease
Again pulmonary A may be opened under water
Bronchopneu
monia
Slightly elevated,
granular, firm
Gray red to yellow
Poorly demarcated,
patchy distribution
Multilobar, often
basilar
Lobar pneumonia
Consolidation of large
areas of lobe or entire lobe
Stages
Congestion – lungs heavy
boggy
Red hepatization – airless,
red, firm ( liver like
consistency )
Gray hepatization – gray
brown, firm, dry
Resolution – return to
normal app of parenchyma
Organization – firm, gray
tan
PNEUMONIA
LUNG ABSCESS
Atypical viral / interstitial
pneumonia
Heavy red with prominent white
streaks indicating outlines of
lobules
U/L or B/L, patchy or confluent
consolidation
Lung abscess
Yellow or red yellow areas filled
with pus In the midst of a
pneumonic area
Follows infarct, pneumonia
Gangrene of lung
Irregularly bound cavity with
green brown foul smelling liquid
CHRONIC DIFFUSE INTERSTITIAL
LUNG DISEASE( RESTRICTIVE)
Coal workers
COAL WORKERS
ANTHRACOSIS LUNG
PNEUMOCONIASIS
pneumoconiasis(CWP)
Anthracosis – large
firm black coloured
progressive massive
fibrosis or
complicated CWP –
black scars 2 – 10cm
diameter. Usually
multiple.
Simple CWP-coal
macules and coal
nodules.
PNEUMOCONIOSIS:FIBROUS PLEURAL PLAQUE
Dr.
D.G
oma
thin
aya
gam
,
M.D.
Silicosis – hard
scars with central
softening and
cavitation. Fibrotic
lesions in hilar
lymphnodes and
pleura
ASBESTOS RELATED DISEASES
Localised or diffuse pleural fibrosis.
Pleural effusions.
Lung carcinoma.
Mesothelioma.
Honey comb lung
- end stage
interstitial
fibrosis – cysts of
varying size surrounded
by gray tan parenchyma
INTERSTITIAL LUNG DISEASE
TUBERCULOSIS
Primary pulmonary
TB
Subpleural GW to
yellow caseous lesion
upper part of lower
lobe or lower part of
upper lobe.
Associated hilar LN
GHON COMPLEX
Dr.
D.G
oma
thin
aya
gam
,
M.D.
TUBERCULOSIS
Early secondary TB
(reactivation )
Small foci of caseous
lesion in apex of one or
both upper lobes
Assosciated regional LN
Progressive secondary
TB (fibrocavitary )
irregular ragged cavity
with casseous material
Healed secondary TB
Fibrocalcific scars ,
cavities in apex
TB LUNG: CAVITATION
Dr.
D.G
oma
thin
aya
gam
,
M.D.
MILIARY TB
Dr.
D.G
oma
thin
aya
gam
,
M.D.
MILIARY TB
Dr.
D.G
oma
thin
aya
gam
,
M.D.
Miliary TB
Minute pinpoint size
nodules throughout
the lungs
Easy to palpate
FUNGAL INFECTIONS
Histoplasmosis
Minute nodules
resembling TB
Later scars with concentric
calcification
Blastomycosis
Discrete nodules with
caseous lesions
Cavities not large
Coccidioidomycosis
Bronchopneumonia with
minute nodules
Aspergillosis
Immunocompromised
host
Necrotizing
pneumonia with
hemorrhagic borders
LUNG TUMOURS
PRIMARY
CARCINOMAS
Squamous cell ca
Gray yellow, white
masses with or
without cavitation
predominantly
central
90% occupying
segmental or large
bronchi
CA LUNG EXTENDING FROM HILUM TO
PLEURA
Dr.
D.G
oma
thin
aya
gam
,
M.D.
Adenocarcinoma
Gray or white
peripheral mass
Cavitation rare
Necrosis may be
present
Bronchioloalveolar
carcinoma
Single nodule or
multiple diffuse or
coalescing GW nodule
Covered by sticky
mucoid material
Resembles pneumonia
Large cell carcinoma
Soft, gray or tan
Somewhat fleshy
mass
Generally arising
centrally
Carcinoid tumors:
Polypoid mass projecting
into bronchial lumen.
Central /peripherally.
SECONDARY
TUMORS
MC – from breast,
thyroid, suprarenal,
kidney
REFERENCES
Pathologic basis of disease-Robbins and
Cotran.8th edidion.
Autopsy diagnosis and technic-Otto saphir.
4th edition.
Handbook of autopsy practice-jurgen
ludwig.3rd edition.
Autopsy pathology-A manual and
atlas.Walter E.Finkbeiner.2nd edition.
THANK YOU