Abstract

Background: Lungs are incidentally involved in nearly all terminal death events and are frequently studied during postmortem examination. Histopathological lung examination helps us to understand disease processes and detect incidental findings and study their association with different variables. Aims & objectives: a. To evaluate the pulmonary histopathological features in adult and pediatric medico-legal autopsies. b. To determine the frequencies of the various causes of death and study their association with age and gender. Methods: Lung specimens of all medico-legal autopsies received between January 2018 to December 2023 at a tertiary care centre were retrospectively studied for gross morphological findings. Further, the specimens were fixed and representative sections were submitted, processed and stained with H & E routinely to study histomorphological findings. Final diagnosis was given after correlating gross and histomorphological findings. Results: Among 270 autopsy cases, the most common cause of death in adults was cardiac pathology (28.9%), followed by primary pulmonary pathology (20.4%). Common pulmonary findings in cardiac deaths included edema and chronic venous congestion, while interstitial pneumonitis (10.2%), edema, and bronchopneumonia were predominant in primary pulmonary causes. In children, deaths were mainly due to accidental emergencies (32%), respiratory failure (24%), and aspiration (12%), with pulmonary findings such as edema, congestion, aspiration pneumonitis, and pneumonia. Histopathologically, aspiration (20% vs. 1.63%), pneumonia (32% vs. 17.14%), interstitial pneumonitis (24% vs. 10.2%), and hemorrhage/infarct (20% vs. 11.02%) were more frequent in children than adults; emphysema, granulomas, and thrombi were absent in children. Age-wise, coronary artery disease was prevalent in middle-aged adults, RTA and poisoning in younger adults, and malignancy in the 30–50 age group, with findings statistically significant (p < 0.05). Incidental discoveries included pulmonary saddle embolus and primary pulmonary carcinoma. Conclusion: This study validates the routine histopathological examination of lungs in all paediatric and adult autopsies as it yields a treasure trove of information including unexpected and incidental findings which significantly contribute to the cause of death. The study also highlights the role of pulmonary pathology in the paediatric population.

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