Color Atlas of the Autopsy

Scott A. Wagner

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781315352701
• Edition: 2
• Topic: Droit
• Subtopic: Science médico-légale

In keeping with the spirit of the first edition, the second edition of this book displays the autopsy procedure in a step-wise, start-to-finish fashion. While the autopsy itself has changed little over the last 100 years, the adjunct procedures—toxicology, radiology, and DNA analysis, among others—have changed greatly. Original chapters are fully updated and modified to reflect changes in the last 15 years. Additionally, two new chapters have been added on natural death and organ/tissue donation.

LIST OF VIDEOS

Video 2.1 Medical/circumstantial history: https://goo.gl/vChcBI. Knowing the circumstances of the death, and the medical history, if pertinent, are the cornerstones of a death investigation.

Video 3.1 External examination: https://goo.gl/rkd8va. The findings of the external exam, act as clues or guides for findings on the internal exam. In a forensic investigation, the external examination documentation and photography may take longer than the internal exam.

Video 3.2 Rigor mortis: https://goo.gl/UXAl4Q. The stage of rigor mortis is determined by examining the jaw, fingers, hands, arms, and legs.

Video 5.1 Skin exam and livor mortis: https://goo.gl/0f4BSB. The Skin acts as a sentinel for diseases or injuries inside the body. Livor Mortis is a discoloration of the skin by blood settling in the gravity dependent areas of the body, and is assessed during the external examination.

Video 6.1 Internal exam, opening the body and the Y incision: https://goo.gl/QzDYz7. The body is opened, looking constantly for bruising, fractures or other abnormalities.

Video 7.1 Opening the chest and collecting blood for toxicology: https://goo.gl/VKhlPZ. The chest is opened carefully, looking for air or fluid. Blood for toxicology is a cornerstone of the autopsy. Peripheral blood (femoral or brachial) is preferred as some drugs can concentrate in the centrally in the heart and great vessels after death (post mortem redistribution)

Video 7.2 Heart and lung excision: https://goo.gl/8x97Zo. The heart and lungs are carefully removed. Looking for emboli in particular.

Video 7.3 Abdominal assessment: https://goo.gl/Jqqqrz. The abdominal cavity must be inspected before the organs and bowel are removed.

Video 8.1 Examination of heart, lungs and liver: https://goo.gl/GnHqPY. These organs are examined as they are removed.

Video 8.2 Aorta examination: https://goo.gl/wGZ34e. The aorta can have atherosclerosis, aneurysms and dissections, and should be opened to look for these and other conditions.

Video 8.3 Neck examination: https://goo.gl/65uW6S. In forensic cases in particular, the strap muscles, hyoid bone, superior thyroid cartilage, and tongue should be examined for hemorrhage and injury to rule out strangulation and other conditions.

Video 8.4 Detailed examination of the heart: https://goo.gl/93qmkM. The heart is dissected in detail as the many deaths are cardiac in nature, chief among them being coronary artery atherosclerosis.

Video 8.5 Detailed examination of lung: https://goo.gl/f47Eeh. The lung is examined for the common conditions including pneumonia, tumors, and emboli, among many others.

Video 8.6 Detailed examination of liver: https://goo.gl/x5zAnq. The liver can display lacerations, which are often fatal. Common medical conditions include cirrhosis and metastatic tumors.

Video 9.1 Removal of the brain: https://goo.gl/V7pMPa. The brain is examined in every forensic case, as one can have direct observations of tumors, trauma, aneurysm, and stroke, among many other possible findings. If the brain is not examined, questions and speculation can be raised regarding the presence of trauma or disease contributing to the cause of death.

CHAPTER 1

APPROACH TO THE AUTOPSY: PURPOSE AND PHILOSOPHY

To the living we owe respect, but to the dead we owe only the truth.

Voltaire

WHAT IS AN AUTOPSY?

The autopsy answers the final question: why did life pass from the body of this individual? It is a question we have all asked when a loved one, friend, coworker, or even a public figure dies. The more untimely the death, the more tragic it seems, so many more questions arise. A wife asks why her healthy husband suddenly collapses, unresponsive. A young bricklayer cries out in pain and falls to his death from a great height as his coworkers look on in horror. An entire country wants to know how its president was assassinated. The autopsy serves to answer these and many other questions.

The autopsy is a complete evaluation of an individual’s death and the circumstances surrounding that death. It includes a full examination of the body, and the autopsy has been called “the ultimate physical examination.” This examination includes:

• A complete evaluation of the medical history and circumstances leading to the death
• The documentation of the position of and trace evidence on and around the body
• The photographing, description, and cataloging of injuries
• A detailed external examination of the body from head to toe
• An internal examination, including the dissection and examination of organs and tissues
• A microscopic examination of organs and tissues
• Laboratory and toxicological examinations of blood, body tissues, and fluids
• A written report detailing the pertinent findings, negative findings, and conclusions, including the cause and manner of death

A common misconception is to think of the autopsy as simply a dissection of organs. While the autopsy does involve dissecting organs, it is a much more comprehensive study of a person’s death. The dissection portion of the autopsy is only a part of the complete examination that a pathologist performs. More than a simple medical procedure, the autopsy is a comprehensive consultation with the pathologist and part of a complete death investigation. Your family doctor takes the same approach. For example, you may go to your doctor because you are “tired all the time and want to find out why.” You know your doctor will listen to your heart and lungs, but you want him or her to do more because your sluggishness might not be caused by a heart or lung problem. You want the doctor to use any means available to find out why you are so tired. He or she might have to perform blood tests or x-rays or take a detailed history from you. The pathologist approaches the autopsy in the same fashion, finding all of the medical or scientific facts, whether they lie in the medical history, dissection, examination of tissues, or toxicology results. The facts obtained in the autopsy are used to form opinions. The key opinions are usually the cause and manner of death, but can include important factors such as the time of death or injury patterns leading to finding the murder weapon.

The body of the decedent is treated with respect and dignity. The pathologist views the decedent as his or her patient, and accordingly treats the body as he or she would a family member. Except in rare and unusual circumstances, the autopsy does not alter any viewable portions of the body. Visitors to the funeral service cannot recognize that an autopsy has been performed, as the autopsy is much like a surgical procedure. A common misconception is that an autopsy can “mutilate” the body. On the contrary, this book will show how skillfully and precisely an autopsy is performed.

TYPES OF AUTOPSIES: HOSPITAL AND MEDICAL–LEGAL

There are two types of autopsies: hospital ...