autopsy techniques

1. Autopsy Techniques
Presenter: Dr Himachal Mishra
Moderator: Dr Shakuntala S Aramani
Associate Professor, Department of Pathology

2. Overview
•Introduction
•History
•Objectives
•Various Techniques
•Examination of organs
•Removal of organs
•Summary

3. Introduction
• Autopsy: Greek “Autopsia” means seeing with ones eyes
• An autopsy is the examination of the dead body to figure
out the cause of death.”
• Autopsies date back to the 5th century.

4. Autopsy Through The Ages…
•Eristratus (310 BC) and Herophilus (335 BC)-----
searched into cause of disease and associated disease
with changes in the organs .
•Galen (129- 201AD) -Dissections on the animals /
primates .

5. • Frederick II- Authorised human dissection and paved way
for medical education.
• With Renaissance medicine and medical education underwent
changes
• Andrea Vesalius -given the duty of conducting public
dissections.

6. • Leonardo da Vinci ( 1452- 1519 ) – made drawings from about 30
human dissections .
• Giovanni Morgagni (1682-1771 )- intellectual founder of autopsy
.
• Karl Rokitansky (1804-1878 ) -performed > 30,000 autopsies.
• Rudolph Virchow ( 1821-1902 ) – founder of modern pathology.

7. Objectives of autopsy
•To identify the cause of death.
•To identify any hereditary disease
•To recognise any congenital anomalies
•To rule out an infectious disease.

8. •Education of medical students
•Information for audit.
•Material for research.
•Accurate data on death for National statistics.

9. Who Can Authorize Autopsy?
•Deceased person
•Surviving spouse
•Children of deceased
•Grand children of deceased
•Parents
•Brothers or sisters
•Cousins
•Friends or any person of legal age

10. Who can perform autopsy?
•Medical examiner
•Qualified physicians and surgeons
•Competent pathologist or toxicologist.

11. Biological safety
General Principles
• Recognition of risks
• Identification of hazards
• Elimination
Emerging Infections
• Tuberculosis
• Hepatitis,
• HIV

12. General Technical Considerations
Autopsy room:
• Well lighted
• Firm table, wooden block
• Large supply of water
• Cleanliness
• Handle with care
“Autopsy is permissible to honour the dead’’

13. Components of a post-mortem room
•Mortuary : For every 100 bed Hospital-4 body
storage space.
: Temp-Main cold storage40 C
-Deep freeze unit - 200 C
•Table– Stainless steel with raised edge all around
- Large deep sink at the foot with both hot
& cold water.
-Suction apparatus

14. Autopsy record
•Name, age, sex, colour, weight, length.
• IP No & Autopsy No.
•Date & time of death.
•Date, time & place of examination
•Name of resident & staff pathologist
•Temp & weather of room
•Name of person who identified the body

15. •Summary of clinical history & diagnosis
•External examination
•Internal examination
Condition and appearance of organs, tissues & cavities.
• Chemical & microscopic examination
• Diagnosis

16. Various Instruments

17. Kinds of Autopsies
There are two kinds of autopsies:
• Forensic/Medico-legal
• Clinical/Pathological Autopsy
Forensic: to find the cause of death for a police investigation.
Clinical: Performed in a hospital
Done to find the cause of death for research.

18. Autopsy techniques
General
1. En Masse (Le Tulle)
2. En Bloc
3. Virchow’s
4. Rokitansky
Special
1. Post operative
2. Needle
3. Endoscopic
4. Restriction of skin incisions
5. Autopsy through surgical wounds

19. 1. En Masse (Le Tulle)
• Organs are removed as a single bulky aggregate.
•Advantages:
• Complete preservation of relationships among organs
• Organs removed and stored for later dissection
•Disadvantages:
• Difficult to handle
• Require assistant

20. 2. En Bloc (Ghon/Zenker)
•Maintain all connections between physiologically
related organs:
• Thoracic pluck, coeliac pluck, urogenital pluck
•Advantages:
• Preserve important anatomic relations without unwieldy
mass of organs
•Disadvantages:
• Multiple organ system involvement complicates procedure
• Skill necessary to remove each block from the body intact

21. 3. Virchow’s
• All organs examined systematically one after the other.
• Brain  spinal cord  abdominal cavity  thoracic cavity
 organs individually removed & sectioned outside body.
• Advantages:
Systematic approach
Simplicity for beginning prosecutors
• Disadvantages:
Destruction of anatomic relationships.

22. 4. Rokitansky (in situ)
• Basic principle: Disturb the connections between organs as
little as possible.
• Dissection occurs in situ with little actual evisceration.
• If abnormality is found, regions removed intact 
combination of en bloc and in situ.

23. • Advantages:
Practical for single examiner
Capability of preserving abnormal anatomic relationships
• Disadvantages:
Expertise necessary to recognize abnormalities

24. Special autopsy techniques
1. Post operative autopsies :
• Most experienced autopsy pathologist must perform autopsies.
• Technique can be changed as required by the specific situation :
-Incision not be carried through operative wounds.
-Fistulas to be filled with a stained contrast medium.
-Don’t remove the drain before their location established.

25. 2. Needle autopsy :
Indications
-invasive procedures are not possible
-If proper infection precautions cannot be taken
-Relatives do not give consent for a complete autopsy
3. Endoscopic autopsies :
Neoplasms & traumatic lesions can be easily identified.

26. 4. Restriction of skin incisions :
-An autopsy permission may specify that only an abdominal
incision to be made.
• With appropriate consent, all cervical, thoracic & abdominal
organs may be removed through such an incision.
5. Autopsy through surgical wounds :
• Autopsy permission is restricted to the reopening of a surgical
wound.

27. External & Internal
Examinations

28. External Examination
•Identification
•Sex differentiation
•Age determination
•Algor Mortis
•Livor Mortis
•Rigor Mortis
•Putrefaction

29. Measurements
•Height
•Weight
•Head Circumference
•Chest Circumference
•Abdominal Circumference

30. External Examination
Sites To acess
Skull trauma / haematoma / abscess / surgical intervention / hydrocephaly &
microcephaly.
Face symmetry / cyanosis / acromegaly / cretinism & myxedema
Eyes Exophthalmos / sclera for pallor, icterus & hemorrhage
Corneas – cataract/ injury/ infections/Arcus senilitis/ KF rings
Nose deformity / gangrene/ hemorrhage / infection / malignancy.
Mouth hemorrhage / infection / malignancy/ ulcers
Tongue Geographic tongue / thick & protuberant
Ears Pus/fluid & blood
Neck Thyroid enlargement, vein prominence, lymph node enlargement
Skin Pigments, rashes, redness, nodule
Back bed sore / livor mortis / deformity
Breast Mass
External
genitalia
abnormal development, edema, local infection, testicular atrophy or enlargement
Lymph
nodes
enlarged? Matted or non matted

31. • 1st - External Examination
• height/weight
• Photography
• UV exam (fluids)
• 2nd - Toxicology
• Nail scrapings
• Fluid samples
• 3rd - Internal Examination
• Head (circular saw)
• Chest (incision)
• Abdomen
Steps of Autopsy

32. Securing CSF
Cisternal puncture
:Turn head in lateral position & flex maximally
: Sterilize the skin with iodine & acetone.
: Insert LP needle above 2nd vertebra & push it
upward in the midline.

33. REMOVAL OF BRAIN
• Incision of scalp :

34. Sawing of cranium
• Look for extradural hematoma
• Open superior sagittal sinus with scissors-
look for thrombus.
• Cut dura at the level of incision of
skull & fold dura back to the midline.

35. Removal of brain

36. Triangular incision on orbital plate
Inject full strength formalin into the eyeball
Wait for ½ hr for fixation
Expose optic N
Exert traction Removal of the eyes
cut away posterior half bulbus oculi
Replace orbit with an artificial eye.
Removal of the eyes-----A. Posterior method

37. Anterior removal of the eye

38. Different methods of Brain Fixation
1. Immersion
• Passing a thread underneath the basilar artery in front of pons.
• Pontine infarcts or other lesions- pass under ICA/ MCA.
• Thread passed through short dural flaps on either side of falx.
2. Perfusion
• Perfusion of large amount of fixative use-embalmer’s pump
• Gravity-feed method- infusion bottle raised 150–180 cm above
the specimen.

39. • Gross examination of brain :
• Weight in gms : Males : 1400 Females : 1275
At birth : 335
• External surface : Look for
--Symmetry
--Swelling or atrophy
--Herniation
--Softening
--Any tumors / infarcts / contusions.
--Meninges – pus / hemorrhage.

40. Sectioning of Brain

41. Approach to dissection of brain stem & cerebellum

42. Various sections from brain

44. Fourth Incision
Useful
• Death due to vehicular incidents.
• Death in suspected tortured cases
• Death due to freshly inflicted
deep-seated bruise in the
posterior aspect of the body.
Advantages
• Seepage nil
• Better acceptance
American Journal of Forensic Med Pathol. 2010; 31: 37-41.

45. Removal of neck organs :
•With an amputation knife cut beneath the skin & platysma
muscles of neck to mandible.
•With blunt ended scissors, define & isolate CCAs
throughout its extent. Retract them laterally.
•Cut across the top of larynx & dissect out neck organs.
•Remove tongue, tonsils & soft palate by cutting through
the floor of mouth & incising junction between the hard &
soft palate .
•Examine the teeth, mandible & buccal cavity by
palpation.

47. Initial Dissection & Internal Examination
A B
C D

48. • In situ examination :
a) Note the situs of thoracic & abdominal organs :
- Situs solitus – normal position of organs.
- Situs inversus – complete reversal of normal position.
- Situs ambiguous – situs is not clear
b) Presence & absence of spleen & their number :
-Asplenia – absence of spleen
-Polysplenia – Presence of multiple splenicules on both the sides.

49. c) Note direction of the apex :
-Levocardia – apex pointing to the left.
-Mesocardia - apex pointing to the midline
-Dextrocardia - apex pointing to the right.

50. Pericardial cavity

51. Pericardial Cavity
• Open the pericardial cavity with the scissors, first vertically & then
towards the apex of heart.
• Normal pericardial membrane is delicate, smooth, glistening &
transparent.
• Normally pericardial fluid: 5-50 ml, pale yellow & clear.
• Dry pericardium extreme dehydration  cholera

52. • Types of fluid encountered in pericardium :
-Transudate – hydropericardium
-Exudate – serous pericarditis
-Pus – purulent pericarditis
-Blood – hemopericardium
Pericarditis
Acute – fibrinous, serous, purulent, hemorhagic.
Chronic : Granulomatous, chronic adhesive, chronic
constrictive

53. Suspected cases of air embolism
• Ligate the root of aorta tightly.
• Make a 3 cm incision on the pericardial sac anteriorly.
• Elevate the edges of this incision & inspect the contents of the sac.
• Fill the pericardial sac with water & submerge the heart.
• Cut across the left circumflex & descending branch of LCA.

54. • Milk the left coronaries with the finger towards the incision.
• Bubbles will escape if air is in the coronaries.
• Repeat this maneuver with the RCA.
• Under water, incise the RA, RV & PA –Look for air bubbles.
• Examine the LA, LV, SVC, IVC & PVs in a similar manner.

55. Methods for demonstration of pneumothorax

56. Pleural cavity :
--Examine the pleural cavity for any fluid. If present collect atleast 50
ml in a clean dry vessel.
--Classification of pleural effusions :
Transudate Exudate
-Circulatory congestion - Bacterial/Mycotic/Protozoal infection
-Lymphatic obstruction - Malignancy
-Hypoproteinemia - Rheumatic fever
-Meigs syndrome - Collagen diseases
-SVC obstruction

57. A raised, swollen, red localised pleural area- lung infarction.
Meatstatic nodules of carcinoma & sarcoma grey white or
red subpleural nodules.
Mesothelioma of pleura – plaque on visceral/parietal pleura.

58. Lungs
--Fibrocaseous tuberculosis- Adhesions between the pleura & the chest
cavity in the subapical portion.
--Emphysema- Subpleural emphysematous bullae over the lung.
--Collapsed lung – small lung with wrinkling of visceral pleura.
--Bacterial pneumonia – Red to grey yellow colored foci of
consolidation, firm & rubbery in consistency.

59. Pulmonary metastasis – Mc site: periphery of the lung.
- Single/multiple grey white to reddish areas.
--Miliary tuberculosis –Lung studded with millet seed like foci of
lesions all over subpleural surface of lung.

60. Examination of abdominal cavity
Explore the cavity with the gloved hand & note the position of
omentum & the sizes of spleen, liver & kidney.
Examine omentum for fat necrosis, tumor deposits & tubercles.
Note if any fluid is present.
Search for orifices into hernial sacs.
Examine female genitalia to determine the condition of the ovaries,
adhesions about the tubes, size & position of uterus

61. 1. Examination of Liver
• Determine the height of each dome of diaphragm with respect
to the ribs / intercostal spaces & record this finding.
• Note the downward extent of liver in the mid-clavicular line,
measure this distance in cms & record this finding.
Amyloidosis,
Fatty Liver
Storage Disorders
CVC
Malaria,
Amoebic abscess,
Tumor masses.
Small, brown to yellow
in color with wrinkling
of capsule.
Hepatomegaly-
Atrophic liver

62. Consistency – normally –semisolid.
It is diminished in necrosis & severe fatty change.
Increased in amyloidosis & cirrhosis.
Post mortem color of liver - deep blue - CVC
- green – if seepage of bile
Putrefaction changes - Honeycomb of gas bubbles.
Nut meg appearance  CVC

63. Amyloidosis  Translucent waxy appearance
Pale infarct  Obstruction of hepatic artery
Malaria  dark gray or salty appearance
Miliary TB  studded with millet seed like lesions
Amoebic abscess  large abscess
Metastasis in liver  multiple, gray white nodules

64. Spleen
Hemochromatosis  reddish-brown color
Chronic malaria  gray to black.
Splenic infarcts  pale
Amyloidosis  waxy translucent appearance / sago spleen.

65. 2. G.I.T.
Examine entire GIT carefully for perforation.
Gastric ulcer perforation- a serosal fibrinous exudate, may be purulent.
Perforation of a chronic duodenal ulcer:
Anteriorly & in ‘supracolic compartment’.
Look for gangrene of small intestine & appendix.
Look for malignancies of the stomach, intestines or any other serosal
tumor deposits.

66. Removal of Organs

67. 1. REMOVAL OF THORACIC ORGANS
• Remove the heart by lifting it up & cutting through the vena cavae &
pulmonary veins from beneath.
• Sever the aorta & pulmonary artery & remove the contents with a
forceps.
• Place the heart in a pan.

68. • Remove the lungs by cutting through the hilar structures :

69. 2. Removal of upper abdominal organs
• Open stomach along greater curvature in continuity with esophagus.
• Incision of greater curvature is continued into duodenum & all the 4
parts are opened.
• Gall bladder is squeezed gently to look for bile coming out of the
ampulla of Vater in the 2nd part of duodenum.
Bile flows freely Bile does not flow freely

70. •If the bile flows freely
• Connection of the liver with the gut can be severed by cutting portal V,
CBD & hepatic artery.
Dissect hepatoduodenal ligament
• Raise left lobe & cut left triangular ligament with a scissor.
• Raise right lobe & cut right triangular ligament with a scissor.
• Cut the IVC below the diaphragm & free any remaining attachments
• Cut falciform ligament & gastro-duodenal ligament from inferior
surface of liver.

71. If bile does not flow freely
En block removal of upper abdominal organs must be done.
Separate diaphragm from ribs & posterior abdominal wall. Free the
lower end of oesophagus from the diaphragm.
Separate spleen & dissect pancreas out of retroperitoneum, beginning
with its tail.
Tie first part of jejunum & working towards pylorus, liberate
duodenum & head of pancreas without damaging CBD.
Lift liver & cut it free of any remaining attachments to diaphragm &
IVC.
Entire block of organs can now be shifted out.

72. 3. Removal of abdominal & retroperitoneal organs
Removal of intestines :

73. Removal of intestine

74. Removal of genitourinary system :

75. Removal of male reproductive system :

76. Pull uterus, cervix & vagina upwards
Divide vagina as low as possible
FTs, uterus & ovaries are freed from
pelvis & are removed
Removal of female reproductive system

77. • Removal of bladder along with prostate & seminal vesicles &
terminal segment of rectum :

78. Summary
•Autopsy is examination of dead body to find the cause.
•Y is the most common primary incision given, but with
time some modification has been done.
•It includes thorough external and internal examination,
including opening of all the body cavities for proper
visualization of all the visceral organs.
•Knowledge of different diseases and their gross appearance
is must to know the leading cause of death.

79. References
1. Ludwig J, Handbook of autopsy practice.2002; 3 :4-302
2. Vaideeshwar P, Lanjeswar D, Autopsy practices, 2021; 2: 1-204.
3. King, Meehan. History of autopsy. American journal of
pathology,1973; 73(2):2-32.
4. Finkbeiner WE, Ursel PC. Autopsy Pathology- a manual and
atlas, 2009; 2: 2-104.

80. 5. Dehner LP. The medical autopsy: Past, present and dubious
future. Missouri medicine. 2010; 107(2): 94-100.
6. Bauthier JP. Autopsy and identication techniques. Research
and Technology. 2011;33 :691-714.
7. Patowary A. The Fourth Incision- A Cosmetic Autopsy
Incision Technique. American Journal of Forensic Med
Pathol. 2010; 31: 37-41.

81. THANK YOU