The respiratory system includes the larynx (voicebox), trachea (windpipe) and lungs.The lungs are intimately associated with the heart and circulatory system through the pulmonary arteries (supply blood to the lungs), and pulmonary veins (bring oxygenated blood back to the heart and then to the rest of the body).

Autopsy examination of the lungs includes dissection of the pulmonary arteries, looking at veins, removal of the lungs from the chest cavity and examination of the outer lung surfaces (pleura). The medical examiner dissects and examines the internal lung structures (arteries, veins and airways), then slices open the lungs with a knife to reveal the lung tissue (parenchyma). Finally, as with the other organs, the medical examiner analyzes the lung tissue under the microscope to look for abnormalities in the tissue and cellular level.

When examining the lungs you want to look at the overall appearance and structure. The normal left lung has two lobes, the right has three lobes.The surfaces of the lung should be smooth and glistening. If not, you may see scars or air pockets indicative of lung disease such as emphysema. Anything obstructing the blood vessel and airway openings would be considered abnormal.

The lung tissue (parenchyma) should have a uniform coloration that is typically light pink to dark red-purple. Any areas of distinct coloration should be noted. Diffusely speckled black pigmentation in the lungs should be noted (and is often seen in today’s industrial society due to air pollution). Any other distinct masses or areas of discoloration should be noted also.

Finally, microscopic examination of the lungs should show a lot of clear spaces (alveoli), indicating a lot of air in the lung tissues. Anything that shows occlusion or blocking of the air spaces or blood vessels would be abnormal.

Gross Images

Photograph of a normal lung. Small amount of black pigment is normal in industrial societies.

Photograph of normal lungs still in body cavity

Photograph of a normal pulmonary artery

Examining the lungs for blood clots is done solely at gross examination (with the naked eye). Blood clots in the lungs will show up as blockages in the arteries. Often these look like a “bag of worms” filling up the artery lumen (open space) and some times bulging out of it when you cut the artery open. After you see one case of the blood clots in the lungs, this disease is easy to distinguish from other diseases and is readily identified.

Microscopic examination for blood clots in the lungs is not helpful in the majority of cases since this is a gross diagnosis.

Gross Images

Photograph of a pulmonary embolism (blood clot in lung)

Emphysema is a lung disease associated with cigarette smoking. In emphysema the lungs are damaged to the point that the tissue is eaten away resulting in large airspace (called bullae or blebs) that can get very large and not effectively transport oxygen into the blood stream. The lungs in emphysema typically have a dark black coloration (from smoke damage) and will have many outpouchings of air pockets (blebs and bullae) visible on the lung surface. You may also see large areas of scarring due to lung damage from the smoke.

Anthracosis is black pigment discoloration in the lung tissues. Severe cases of anthracosis are typically due to cigarette smoking or seen in mine workers.In today’s industrial society, most people have some anthracosis, or black pigment, in their lungs due to air pollution.

Gross Images

Photographs of lungs of a light smoker: Image 1, Image 2, Image 3.

Photograph of a lung with emphysema

An autopsy report of the lungs should include descriptions of the following areas:

• The overall appearance of the lungs, noting coloration and any abnormal pigmentations.
• A description of the blood vessels and airways, noting if they are patent (open) or occluded (blocked) by something.
• A description of the pleural, or outside, surfaces of the lungs, noting if they are smooth, rough, scarred or have other changes.A description of the cut surface, noting the coloration of the parenchyma (lung tissue), any abnormal areas of coloration, distinct masses or other findings.Anything else that catches your attention.