Forensic Pathology (and Autopsy Pathology)

General: Although there are differences between academic/hospital autopsies and forensic autopsies/pathology, there is enough overlap and similarity that the two are dealt with together here. In very general terms, historically the academic autopsy is highly detailed for teaching purposes, while the forensic autopsy focuses on cause, mode, and manner of death. As of this writing, relatively few institutions still utilize a true academic autopsy as compared to, say, 50 years ago — although those that do still approach it with due vigor.

Basic components: It should be stressed that there is a certain amount of leeway given to the staff pathologist regarding the extent of their post-mortem examination. In some forensic cases this may only involve an external examination; determinants of the extent of autopsy include institutional protocols, history, circumstances of death, experience of the prosector, likelihood of being a legal case, research requirements, and whether it is a teaching autopsy. The basic components of a standard full, unrestricted autopsy generally include:

• External examination: A general assessment of height, weight, hair, teeth, skin, scars, tattoos, livor mortis, rigor mortis, evidence of injury, and evidence of treatment/medical intervention. This can be very lengthy and complex, or extremely short and simple. In forensic cases this generally includes photographs, sometimes numerous.
• Internal examination: One of several possible incision methods is used, generally opening the body from the upper chest to about the pubis along the midline. The anterior chest plate is cut away, thus exposing the internal organs from the thoracic inlet/outlet to the pelvis. One of several possible organ extraction methods is then used, and ultimately each of the major internal organs is examined in turn, from the larynx to the bladder & rectum:
  • Heart & great vessels: An examination of the pericardium (for fluid) and the pulmonary artery (for large pulmonary emboli) may be made in-situ, prior to organ extraction.
  • Lungs & trachea: An examination of the pleural cavities is made in-situ, prior to organ extraction.
  • Thymus: (Usually visible only in pediatric cases.)
  • Thyroid: Often examined only after organ extraction, but is dependent on the method used.
  • Major arteries & veins: The aorta should be opened and the major arterial branches opened & examined at least at their branch points, down at least as far as the iliac vessels. The most common abnormalities are calcific atheromas and stenosis. Further examination is usually "as indicated."
  • GI tract:

...

(CAP: An Introduction to Autopsy Technique, 2nd ed., 2005)

Images:
Link out to a CAP.org PDF file of Autopsy Diagrams, 2005