Failure, Congestive Heart

NOTE: Coronary atherosclerosis and manifestations of ischemic heart disease,* valvular heart disease, congenital cardiovascular diseases, and manifestations of systemic or pulmonary hypertension are the most frequent findings in patients dying of or with congestive cardiac failure. Other causes include cardiomyopathies* and secondary myocardial disease (such as amyloid or pericardial constriction). If the cause of the congestive

Organs and Tissues Procedures

External examination

Chest and abdominal cavities Heart and great vessels

Other organs

Failure, Kidney

Synonyms and Related Terms: Acute kidney failure; chronic kidney failure; renal failure; uremia.

NOTE: If acute kidney failure had been diagnosed, the autopsy procedures will depend on the expected causes, such as poisoning with ethylene glycol,* lead,* mercury,* or methyl alcohol;* disseminated intravascular coagulation* and its various under-

Organs and Tissues Procedures

External examination and skin

From: Handbook of Autopsy Practice, 3rd Ed. Edited by: J. Ludwig © Humana Press Inc., Totowa, NJ

cardiac failure is unknown or not immediately evident after dissection of the heart and of the great vessels, myocardium and other appropriate tissues may be submitted for microbio-logic study—including viral cultures (p. 102)—and for electron microscopy (p. 132). Specimens can also be snap-frozen for possible immunofluorescent, biochemical, or histochemi-cal studies, particularly of the myocardium.

Possible or Expected Findings

Cyanosis; edema of legs; dilatation of veins. Cardiomegaly; pleural effusion(s).* Hydrothorax; ascites.

Possible causes of congestive cardiac failure are too numerous to mention. Dilatation of heart, with or without mural thrombosis. Myocardium may be soft, normal, or firm.

Pulmonary congestion, with or without hemosiderosis; congestion of viscera with organomegaly. Other organ manifestations include bowel edema or hemorrhagic enteropathy (without mechanical vascular occlusion) and zonal hepatic steatosis, fibrosis, or necrosis, with or without evidence of liver failure. Acute renal tubular necrosis may be present also.

lying conditions; glomerulonephritis* and its various underlying conditions; diabetes mellitus;* or multiple myeloma.* The procedures described below deal primarily with chronic renal failure. If the patient had had dialysis, see also under "Dialysis (for chronic renal failure)." If transplantation had been carried out, see also under "Transplantation, kidney."

Possible or Expected Findings

"Uremic frost." Uremic skin discoloration. Teflon-Silastic shunts. Bone deformities and fractures. (See also below under "Bones and joints.") Metastatic calcifications in soft tissues and bursae.

Record body weight and length. Prepare roentgenogram of chest. Record volume and character of effusion(s).

See above under "Note." Record weight of heart, valve circumferences, and ventricular wall thickness. Estimate extent of dilatation of each cardiac chamber. Note consistency of myocardium.

Organs mentioned in right-hand column should be described and, if appropriate, weighed and measured. Submit samples for histologic study.

Submit samples of skin for histologic study. Record position of shunts. Prepare skeletal roentgenograms and roentgeno-grams of soft tissues.

Organs and Tissues


Possible or Expected Findings




Blood vessels


Esophagus Gastrointestinal tract


Pancreas Kidneys

Urine Testes

Parathyroid glands Brain and spinal cord


Skeletal muscles Bones and joints

Submit sample for determination of urea nitrogen, creatinine, sodium, and chloride concentrations (p. 85).

Submit sample for microbiologic study (p. 102). Retain frozen serum for serologic or immunologic study. Submit sample for determination of urea nitrogen and creatinine concentrations.

If infection or clotting of shunt is suspected, remove shunt together with ligated vessels and submit for culture.

Submit one lobe for bacterial, fungal, and viral cultures (p. 103); prepare smear of fresh cut section for the demonstration of Pneumocystis carina.*

Collect fresh lung samples and freeze for possible immunofluorescent study. Perfuse one lung with formalin (p. 47).

Record character of contents; submit tissue samples for histologic study. For gross iron staining, see p. 133.

Submit samples for histologic study. For renal arteriography, renal venography, and retrograde urography, see p. 59. For other procedures, see under name of specific renal disease.

Collect and submit sample for urinalysis. Submit samples for histologic study or rete testis. Record weights; submit samples for histologic study.

For removal and specimen preparation, see pp. 65 and 67, respectively. If the choroid plexus is to be used for immunologic study, dissect fresh brain and snap-freeze plexus. For removal and specimen preparation, see p. 85. For sampling and specimen preparation, see p. 80. For removal, prosthetic repair, and specimen preparation, see p. 95.

For interpretation of findings (biochemical diagnosis of uremia), see p. 115.

For interpretation of findings, see p. 114.

Myocarditis;* pericarditis.* Infected shunts; manifestations of hypertension;* metastatic calcification.

Bacterial, fungal, viral, and/or uremic pneumonitis; pulmonary edema.

Candida esophagitis. Hemorrhages; gastroenteritis.

Transfusion hemosiderosis.

Chronic hepatitis C.

Inspissation of pancreatic ducts.

See under name of specific renal disease, such as "Glomerulonephritis." Acquired cystic disease may occur after long-term intermittent maintenance hemodialysis.

Cystic transformation of rete testis (1). Hyperplasia, with or without adenoma(s).

Edema and petechiae. Neuronal damage.

Hypertensive retinopathy; steroid cataracts. Myopathy.

Renal osteodystrophy (osteoporosis;* osteomalacia*). Gout.*


1. Nistal M, Santamaria L, Paniagua R. Acquired cystic transformation of the rete testis secondary to renal failure. Hum Pathol 1989;20:1065-1070.

Failure, Liver

NOTE: See under name of suspected underlying disease, such as "Cirrhosis, liver" or "Hepatitis, viral."

Failure, Lung

NOTE: See under name of suspected underlying conditions such as "Pneumonia,...," "Syndrome, adult respiratory distress (ARDS)," or "Syndrome, respiratory distress, of infant."

Fascioliasis (See "Clonorchiasis.")

Feminization, Testicular

Related Term: Hereditary male pseudohermaphroditism. NOTE: This x-linked recessive condition is characterized by impairment of male phenotypic differentiation or virilization; it occurs in a complete and an incomplete (see below) form. Together with Reifenstein's syndrome* and the infertile male syndrome, these conditions represent androgen receptor disorders.

Organs and Tissues


Possible or Expected Findings

External examination and breasts

Blood or fascia lata

Gonads and vagina

Record body weight and length. Record appearance of breasts and submit samples of breast tissue for histologic study. Specimens should be collected using aseptic technique for tissue culture for chromosome analysis (see Chapter 10). Record presence of sex chromatin.

Record weights of testes and prepare histologic sections of both. Prepare histologic sections of vaginal mucosa.

Female appearance with female external genitalia; sparse axillary and pubic hair.

Karyotype is 46,XY.

Blind-ending vagina; absent internal genitalia except for testes, which may have descended to inguinae or labia. No spermatogenesis (but Leydig cells and seminiferous tubules are present). In incomplete testicular feminization, partial fusion of labioscrotal folds, clitoromegaly, and normal pubic hair are found.

Fever, Colorado Tick

Related Term: Orbivirus infection. NOTE: (1) Collect all tissues that appear to be infected. (2) Request cultures for orbiviruses (Reoviridae family). This requires animal inoculation, and not all laboratories have the capability of isolating orbiviruses. (3) Special stains are not indicated.

(4) Special precautions are indicated (p. 146). (5) Serologic studies are available from local or state health department laboratories (p. 135). The virus also can be detected by reverse transcription PCR of whole blood specimens (1). (6) This is not a reportable disease.

Organs and Tissues


Possible or Expected Findings

External examination

Your Heart and Nutrition

Your Heart and Nutrition

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