Info

Reference

1. Davison PR, Cohle SD. Histologic detection of fat emboli. J Forensic Sci 1987;32:1426-1430.

Reference

1. Davison PR, Cohle SD. Histologic detection of fat emboli. J Forensic Sci 1987;32:1426-1430.

Embolism, Pulmonary

Synonyms and Related Terms: Bone marrow embolism; foreign body embolism; pulmonary thromboembolism; tumor embolism.

NOTE: If air embolism, amniotic fluid embolism, or fat embolism is suspected, see under those headings. See also under "Phlebitis" and "Thrombosis, venous."

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Pleural cavities Heart

Lungs Veins

Record circumference of legs, 20 cm above and below patella.

For postmortem phlebography, see p. 121. Prepare chest roentgenogram.

Record volume and character of pleural contents.

In the presence of systemic embolism, record patency of oval foramen or presence of septal defect(s).* Open pulmonary arteries in situ. Inspect lumens of hilar pulmonary arteries to detect emboli. Perfuse lungs for a brief period during autopsy and then inspect slices to detect peripheral emboli.

Remove and dissect femoral veins (after embalming) and pelvic veins (p. 34).

Leg edema accompanying venous thrombosis.

Thrombosis most common in deep leg veins. Infarction; pneumothorax* complicating perforated pulmonary infarction. Effusion(s);* serofibrinous pleuritis; empyema.*

Paradoxic embolism. Mural thrombi in right atrium or right ventricle. Thrombi on pacing leads or indwelling central catheters. Bland infarcts are more common in lower lobes; infarct abscesses are more common in upper lobes.

Phlebothrombosis or thrombophlebitis. See also above under "Note."

Emphysema

Synonyms and Related Terms: Chronic obstructive lung disease; pulmonary emphysema; vanishing lung disease. Possible Associated Conditions: Alphaj-antitrypsin deficiency; chronic bronchitis.*

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Heart

Pulmonary artery Lungs

Diaphragm

Stomach and duodenum Liver

Kidneys Bone marrow

Prepare chest roentgenogram (roentgenograms are of limited value for detecting or assessing severity of emphysema).

Record weight of heart and thickness of ventricles. For separate weighing of right and left ventricles, see p. 26. Record width of artery and appearance of intima. For histologic sections, request Verhoeff-van Gieson stain (p. 173). For pulmonary arteriography and bronchography, see p. 50. For gaseous or perfusion fixation, slicing, barium impregnation, preparation of paper-mounted sections, see pp. 46 to 49.

Submit one lobe for microbiologic study (p. 103).

Record thickness; submit specimens for histologic study.

For histologic sections, request PAS stain with diastase digestion (p. 173).

For preparation of sections and smears, see p. 96.

Cyanosis; clubbing of fingers. Low diaphragm; pneumothorax.* Unilateral emphysema (congenital lobar emphysema) in infants. Incidental unilateral emphysema in adults (Macleod's syndrome). Cor pulmonale.

Pulmonary atherosclerosis; broken-up elastic membranes.

Rarefaction of pulmonary artery tree. Chronic bronchitis;* bronchial obstruction; pneumoconiosis.* Emphysema may be centriacinar (centrilobular), focal, giant bullous, irregular, panacinar (panlobular), or paraseptal (distal acinar), or it may be related to scars (para-cicratical airspace enlargement).

Haemophilus influenzae and Streptococcus pneumoniae or other infections. Muscular hypertrophy.

Peptic ulcer(s).*

Centrilobular congestion. In alpharanti-trypsin deficiency,* PAS-positive, diastase-resistant hepatocellular intracytoplasmic globules.

Glomerular enlargement. Increased erythropoiesis.

Organs and Tissues

Procedures

Possible or Expected Findings

Brain

For removal and specimen preparation, see p. 65.

Anoxic changes in cortex, corpus striatum, globus pallidus, thalamus, Sommer's sector of hippocampus, and Purkinje cells of cerebellum. Petechial hemorrhages of hypothalamus and necrosis of cerebellar folia may be present.

Empyema, Epidural

Synonym: Epidural abscess.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Cerebrospinal fluid Skull

Prepare roentgenogram of skull. Submit sample for microbiologic study (p. 104). In order to avoid contamination, aspirate infectious material for microbiologic study as soon as calvarium can be lifted (p. 65)— before complete removal of the calvarium. For exposure of sinuses, middle ears, and adjacent structures, see p. 71.

Infected surgical wound(s). Skull fracture(s).

Mastoiditis; osteomyelitis* of parietal, mastoid, and other cranial bones; purulent sinusitis; skull fracture(s); postoperative state.

Empyema, Pleural Synonym: Pyothorax.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination Pleural cavities

Lungs

Other organs and tissues

Prepare chest roentgenogram.

Record volume and appearance of empyema fluid. Submit sample of empyema fluid for microbiologic study (p. 102).

Prepare smears and request Gram, Kinyoun's, and Grocott's methenamine silver stains (p. 172).

Submit tissue samples of visceral and parietal pleura for histologic study.

Submit any consolidated areas for microbiologic study (p. 103).

Pneumothorax.*

Seropurulent or purulent empyema fluid with evidence of bacteria or fungi. Rarely other infectious agents.

Emboli; infarcts; abscesses; pneumonia (various types); tuberculosis;* lung abscess;* tumor;* surgical or other trauma. Subphrenic empyema* and other intraabdominal inflammatory diseases.

Empyema, Subdural

Synonym: Subdural abscess.

NOTE: Autopsy procedures and possible or expected findings are essentially the same as those described under "Empyema, epidural."

Empyema, Subphrenic

Synonyms: Subdiaphragmatic abscess; subphrenic abscess.

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