[gatagato]

Types of Autopsies
An autopsy, necropsy, or postmortem examination is a completesurgical examination of a body after death. There are generally two types of autopsies: forensic or medicolegal autopsies and hospital or medical autopsies.
Medicolegal autopsies differ from hospital autopsies in that they fall under the jurisdiction of a local governmental death investigation office (typically a coroner or a medical examiner). A coroner or medical examiner may legally order an autopsy and does not require consent from the legal next-of-kin. This contrasts with hospital autopsies where a properly executed and witnessed consent for autopsy that has been signed by the decedent’s legal next-of-kin is
required before an autopsy can be performed.
The cause of death in medical autopsies is often already known and so the purpose of the autopsy is more an attempt to answer specific questions that family members or physicians may have regarding the case. This includes questions on the extent of disease, the effectiveness of therapy, or the presence or absence of other findings.
In view of the focused nature of the questions, hospital autopsies may therefore be limited to an examination of certain body parts or particular organs.




Fig. 7.1
Hospital records are typically available for review prior to hospital autopsies


Fig. 7.2
An example of how blood can obscure the true nature of an injury. In this photograph of a man with a gunshot wound of the head, it is impossible to identify the site of the wound


Fig. 7.3
An example of a typical body diagram used to document injuries at autopsy


Fig. 7.4
Radiography is now commonly used in many types of forensic cases


Fig. 7.5
Collection of blood from the femoral region (groin) is the preferred site for postmortem toxicology testing


Fig. 7.6
Collection of vitreous fluid from the eye can provide important toxicology and chemistry information related to the cause of death


Fig. 7.7
The external examination is of extreme importance in forensic autopsies. Pathologists must document clothing, medical treatment, identifying features, and injuries


Fig. 7.8
Photography is an integral part of forensic autopsies


Fig. 7.9
The classic ‘‘Y-shaped’’ incision used during the performance of an autopsy


Fig. 7.10
The skin and underlying subcutaneous tissues are reflected, thus exposing the anterior (front) chest wall, as well as the opened
abdominal (peritoneal) cavity. In this photograph, the omentum as well as small portions of the stomach and intestines are visible


Fig. 7.11
A bone saw can be used to cut the front of the chest
plate


Fig. 7.12
In young individuals, such as this infant, the
anterior chest plate can be removed by cutting
through the rib (costal) cartilage with a scalpel


Fig. 7.13
The chest plate is removed, exposing the pleural cavities (containing the lungs) and the front of the pericardial sac


Fig. 7.14
After the chest plate is removed and the pleural cavities and lungs are examined in situ (in place), the pericardial sac can be opened
anteriorly to reveal the heart. Organs can be removed together (en bloc) and then dissected, or they can be removed one at a time


Fig. 7.15
Blood samples can be collected directly from the heart, although for toxicological interpretation peripheral blood from the extremities is
preferable


Fig. 7.16
Bile can be collected from the gallbladder


Fig. 7.17
Urine can be collected from the urinary bladder


Fig. 7.18
The small intestines may be removed in one large
block by cutting the base of the mesentery at the
posterior (back) of the abdominal cavity


Fig. 7.19
Alternatively, and preferably, the small intestines may be removed by cutting the mesenteric attachment immediately adjacent to intestine. Removal in this fashion allows the intestine to be more easily opened and examined internally


Fig. 7.20
After the small intestine has been taken out of the
abdominal cavity the large intestine is removed


Fig. 7.21
When organs are removed individually, the lungs can be pulled forward and removed by cutting the mainstem bronchi and the
pulmonary arteries and veins. In this photograph, the left lung is being removed


Fig. 7.22
The heart is pulled forward (upward) and removed by cutting the inferior vena cava, the pulmonary veins, the pulmonary artery and
aorta, and the superior vena cava


Fig. 7.23
The liver must be cut away from the diaphragm, as well as the inferior vena cava and biliary system, in order to remove it from the body


Fig. 7.24
The spleen is reflected forward and cut away from the region near the tail of the pancreas


Fig. 7.25
After the liver and most of the intestines have
been removed, the spleen (white arrowhead),
esophagus (black arrowhead), stomach (arrow),
duodenum, and pancreas (located behind the
stomach – dashed outline) remain within the
body. These organs may be removed in
a variety of ways. Often, the spleen is removed
separately, followed by removal of the other
organs together


Fig. 7.26
The duodenum, the pancreas, the stomach, and
a portion of the esophagus may be removed in
one large organ block


Fig. 7.27
The adrenal glands, located above and medial to the kidneys, are removed. The left adrenal gland is being excised in this photograph


Fig. 7.28
In order to remove a kidney, it is reflected forward, and a scalpel is used to cut through the fat surrounding the organ


Fig. 7.29
After the kidney is exposed, as shown in Fig. 28, the capsule and surrounding fat is peeled away


Fig. 7.30
The pelvic organs (urinary bladder, as well as the prostate in males as shown, and the uterus, fallopian tubes, and ovaries in females) are
then removed


Fig. 7.31
The aorta, along with the bottom portion of the trachea, with
attached mainstem bronchi, can then be removed


Fig. 7.32
Examination of the organ block from behind shows the tongue (T),
aorta (A), lungs (L), and domes of the diaphragm (D)


Fig. 7.33
Individual organ weights are recorded during the
autopsy


Fig. 7.34
The brain being weighed


Fig. 7.35
In this infant case, the organ bloc has been freed posteriorly, first on the right, then on the left, then from below, and finally from above
(as shown)


Fig. 7.36
A stock container with representative tissue/organ samples in formalin (viewed from above)


Fig. 7.37
Small sections of tissues can be placed into tissue cassettes, so that microscopic sections can be prepared


Fig. 7.38
Examination of the removed heart includes serially sectioning the major coronary arteries that are located within the epicardial fat.
The anterior surface (front) of the heart can be seen, with a series of cuts through one of the main coronary arteries (the left anterior
descending)


Fig. 7.39
A cross section of epicardial fat with a coronary artery (arrow) and adjacent vein


Fig. 7.40
Following serial sectioning of the coronary arteries, the heart is also sectioned, beginning at the apex (the lowermost tip) and moving
toward the base (where all of the blood vessels connect)


Fig. 7.41
Examination of the lung includes serially sectioning the organ


Fig. 7.42
Examination of the liver also involves serially sectioning the organ


Fig. 7.43
Examination of the kidney involves cutting the organ in half longitudinally


Fig. 7.44
Sectioning of the adrenal gland


Fig. 7.45
Sectioning of the pancreas


Fig. 7.46
After the trunk organs and diaphragm have
been removed, the trunk appears to be one
large cavity


Fig. 7.47
The initial step required for brain removal includes
making an incision from behind one ear, across the top of
the scalp, to behind the opposite ear


Fig. 7.48
The scalp is then reflected forward, exposing the
underlying skull


Fig. 7.49
After the scalp has been reflected forward, the
decedent’s face will be temporarily covered by the
‘‘inside-out’’ scalp


Fig. 7.50
A bone saw is used to cut out a piece of skull, thus
allowing access to the underlying brain


Fig. 7.51
Depending on the case or office protocol, the
temporalis muscles on the side of the skull can
be trimmed away from the underlying skull, in
order to better visualize the bone


Fig. 7.52
In some instances, the bone can be removed
without disturbing the underlying dura. In such
cases, the skullcap actually peels off the dura as
it is being removed


Fig. 7.53
In other cases, the dura remains adherent to the
inner aspect of the skullcap so that when the
skull is removed, the dura is also removed, thus
exposing the underlying brain


Fig. 7.54
After the skullcap and dura have been
removed, the brain is exposed and ready for
removal from the cranial cavity


Fig. 7.55
In order to remove the brain, it must be gently pulled back, in order to cut the portion of the dura that separates the cerebrum from the underlying cerebellum (the ‘‘tentorium’’). This is followed by cutting of the optic nerves, the pituitary stalk, the carotid arteries, the vertebral arteries,
and the upper cervical spinal cord


Fig. 7.56
After the brain has been removed, it is important to remove
the adherent dura from the inner aspect of the skull to check
for any fractures or hemorrhage


Fig. 7.57
The brain is examined and is usually serially sectioned
in the ‘‘fresh’’ (non-fixed) state, although in some cases
the brain may be fixed in formalin prior to sectioning,
as fixation considerably improves the ability to dissect
brain tissue


Fig. 7.58
A cross section of ‘‘fresh’’ (non-fixed) brain at autopsy
clearly showing symmetrical gray and white matter
with cortical foldings (gyri and sulci)


Fig. 7.59
Examination of the anterior (front) of the neck typically
includes removal of the trachea, the larynx, and the
thyroid gland


Fig. 7.60
When injury to the face is suspected, special dissection is required with removal of the soft tissues of the face from the underlying
skeleton. Here the face has been peeled downward, leaving the eyes in their sockets (orbits)


Fig. 7.61
Face peel-down examination showing injury of and
around the left eye with bleeding (hemorrhage)


Fig. 7.62
Middle/inner ear removal via the base of the skull


Fig. 7.63
Layer-by-layer anterior neck dissection commencing with
a dissection of the skin off the platysma muscle


Fig. 7.64
A frontal view of the superficial platysma muscle. In this case, there is no evidence of injury


Fig. 7.65
Removal of the platysma reveals the underlying sternomastoid muscle at the side of the neck and also the pale submandibular salivary
gland in the center left of the field


Fig. 7.66
An anterior neck dissection in progress, at a level deeper than Fig. 64, beneath the platysma muscle. The arrowheads indicate the
sternohyoid muscles


Fig. 7.67
Anterior neck dissection one level deeper than Fig. 66. The arrowheads indicate the reflected sternohyoid muscles


Fig. 7.68
Anterior neck dissection one level deeper than Fig. 67, revealing the thyroid gland overlying the larynx (arrowheads)


Fig. 7.69
A lateral view revealing the white thyroid cartilage forming the larynx, with the tan-colored thyroid gland below, wrapped around the
tracheas (not visible)


Fig. 7.70
A deeper level of a layer-by-layer anterior neck dissection revealing the thyroid cartilage (arrowhead) and trachea (arrow), after removal
of the thyroid gland


Fig. 7.71
Extensive bleeding of the side of the neck is
due in this case to intravenous cannulation
during attempted resuscitation, and not to
blunt trauma


Fig. 7.72
Viewed from the front of the neck,
symmetrical bleeding of the side of the neck,
with no other bleeding, is most often due to
medical intervention


Fig. 7.73
A very limited posterior neck dissection to check for
bruising


Fig. 7.74
Dissection of the lower extremity in order to identify
deep venous thrombosis (arrows) in the setting of
pulmonary thromboemboli


Fig. 7.75
Spinal cord removal via an anterior (front)
approach using an oscillating saw to take off the
front of the vertebral column. An alternative
method involves removing the spinal cord from
a posterior (back) approach


Fig. 7.76
A body following complete autopsy with
a carefully sutured Y-shaped incision


Fig. 7.77
Bodies are typically stored in freezing rooms or coolers prior to and after autopsy. Coolers can contain individual ‘‘drawers’’ or ‘‘shelves,’’
as shown, or be composed of large walk-in/roll-in units


Fig. 7.78
A hair located within the hair of a homicide victim. The collection of such trace evidence may be extremely important, which is why hair
at autopsy will be examined and combed in certain cases


Fig. 7.79
In some cases, paper (not plastic) bags are placed over the hands at the death scene, in order to preserve any trace evidence that might
be on the hands and/or fingers



Source: The Atlas of Forensic Pathology for Police, Forensic Scientists, Attorneys and Death Investigators (2012)


References
Adams VI. Autopsy technique for neck examination. I. Anterior and lateral
compartments and tongue. Pathol Annu. 1990;25(pt 2):331–49.
Adams VI. Autopsy technique for neck examination. II. Vertebral column and
posterior compartment. Pathol Annu. 1991;26(pt 1):211–26.
Forensic Autopsy Performance Standards. National Association of Medical
Examiners.
Inspection and Accreditation Policy and ProcedureManual, Accreditation Forms,
and Checklist. National Association ofMedical Examiners.
Ludwig J. Handbook of autopsy practice. 3rd ed. Totowa: Humana Press; 2002.
Peterson GF, Clark SC. Forensic autopsy performance standards. Am J Forensic
Med Pathol. 2006;27:200–55.
Prahlow JA. Chapter 3 – hospital versus medicolegal (forensic) autopsies. In:
Prahlow JA, editor. Basic competencies in forensic pathology – a forensic
pathology primer.Northfield: College of American Pathologists; 2006a. p. 5–14.
Prahlow JA. Chapter 6 – medicolegal autopsies: an overview. In: Prahlow JA,
editor. Basic competencies in forensic pathology – a forensic pathology
primer. Northfield: College of American Pathologists; 2006b. p. 33–6.
Sheaff MT, Hopster DJ. Post mortem technique handbook. 2nd ed. New York:
Springer; 2004.

[BLACKOUTx4500x]

Very interesting!

[Karma]

Great post. I love stuff like this.

[AceBoon]

I will never eat spare ribs again!

[jumpingjames69]

fucking hell, why did i look at this when im eating my breakfast, i feel sick as a dog now

[kellyhound]

cool pics and very informative

[blancadon]

There went my appetite.

[Kelseecat65]

The liver
Awesome post!!

[winvens]

A truly excellent post.

[dogleg818]

Great post.