European Journal of Cardiovascular Medicine

Autopsies are done to know the identity, manner, cause of death and approximate time since death.^[1] The condition of internal organs can be revealed by Autopsy and is often followed by histopathological examination of tissues from various organs to relate the cause of death with associated pathology and the correlation between the two. ^[2]

Lungs are one of the vital ingenuous organs in our body and participate in exchange of gases between inspired air and blood and which has dual supply of blood circulation. ^[3,4]

Lung diseases present with complex & variable clinical and radiological presentation which are nonspecific and inspite of advanced technology medically and scientifically some lesions like pneumonia & tuberculosis are undetectable during life time, hence prompt pathology investigations and diagnosis are essential to improve patient’s survival and reduce further morbidity and mortality. ^[5]

Pathological examination of autopsy specimen of lungs gives valuable information like hidden disease, stage of disease and improves clinical diagnosis in spite of modern technologies and helpful for conclusion of cause of death. ^[6]

The present study was taken to determine lung lesions in relation to age and sex and to identify the histopathological alterations spectrum in lung specimens, irrespective of cause of death and sex.

This is retrospective study conducted on post mortem lung specimens in Department of Pathology, Government Medical College, Srikakulam. Study period was from August 2023 to July 2024. All the autopsy lung specimens irrespective of age, sex and cause of death were included in the study and those which were autolysed were excluded from the study. Patient information regarding age, sex, brief history of illness, any medical/clinical findings/investigations, and in situ postmortem findings were obtained from the request form.

All specimens were adequately fixed in 10%formalin. Gross examination of lungs included size, weight, color, consistency, presence of consolidation, nodule, necrosis/infarction, fibrosis/scarring, edema, secretion, status of bronchi was recorded. Sections from representative areas were taken. After routine processing and paraffin embedding, section was cut and stained with H and E stain according to standard procedure. Special stains were used whenever required. All the histological sections were examined microscopically, and findings were noted.

Statistical analysis:  Standard methods of statistical analysis were utilized appropriately. Chi- Square test and p-value were done. p-value< 0.001 was considered statistically significant. Excel software was used and results were demonstrated in the form of tables and graphs.

A total of 117 autopsy lung cases were received during the period of study along with relevant clinical details and autopsy findings. Histopathological examination was done in each case and significant microscopic finding were evaluated. Out of these, 83were males and 34 were females with Male: Female ratio of 2.4:1.

Median age of the cases was 40years with age range from 0 to 80 years. (Table 1) The majority of the lung samples belonged to autopsies carried out in adults between 30 to 40 years age group – 29.91%.

Table 1:   Age wise distribution of cases.

The various Histopathological changes seen in autopsy lung specimens (Table 2) with wide varieties of microscopic findings were seen in lungs which included oedema and congestion, inflammation (acute, granulomatous), changes in interstitium, emphysema and acute respiratory distress syndrome (ARDS).

The predominant finding was chronic venous congestion(fig1) seen in 36 cases – 30.78% followed by pulmonary edema with 26 cases – 22.22%. These cases showed congested blood vessels and intra-alveolar haemorrhages, alveoli distended with protein rich fluid.

Another commonest pathology was changes in interstitium seen in 17 cases – 14.53%. There was broadening of inter- alveolar septae due to mononuclear infiltrate, interstitial fibrosis and increased alveolar macrophages in these cases. Two cases of granulomatous inflammation(fig2) were also seen in 2 cases. Caseous necrosis was present in these two cases and these were diagnosed to be suffering from pulmonary tuberculosis.

There were 15 cases having acute respiratory distress syndrome(fig3) which showed congestion, intra-alveolar oedema, inflammation, fibrin deposition. Few alveoli were lined by waxy hyaline membrane. (12.83%)

Pneumonia (fig 4) was seen in thirteen cases (11.11%) characterized by vascular engorgement, intra-alveolar fluid and neutrophilic infiltrate. Emphysematous changes were seen in three cases which showed large alveoli separated by thin septa and focal fibrosis, few showing ruptured alveoli. There was one case each of Bronchitis and Metastatic carcinoma deposits.

Fig4 Broncho pneumonia(10x:H&E)

Table 2: Distribution of lung lesions based on Histopathology:

The histopathological changes in lung specimens and associated cause of death were studied (Table 3). Cause of death was known in 99 cases (84.62%) of pathological lesions. Poisoning, 41 cases (35.04%) was the most common followed by sudden death (11.11%)

TABLE 3: Distribution of cases according to cause of death

Concomitant lesions were observed in the lungs showing associated findings like chronic venous congestion and pulmonary edema in 21 cases (17.95%) predominantly. (Table 4)

TABLE 4: Concomitant lesions observed in Lung

Autopsy pathological examination is an important diagnostic tool to study the spectrum of various diseases, etiopathogenesis, assessment of various morphological patterns of same disease and also an opportunity to discover new disease.

In our retrospective study of 117 cases, four cases of samples of lungs sent for autopsy were autolysed and those cases were excluded from the study. The sample size (number of cases) correlated with the sample size of Anisha TS et al^[2] having 100 cases and Sumaya et al^[7] having 115 cases.

There was male predominance in our study (70.94%); similar distribution was observed inChhavi Gupta et al^[8], Anisha et al^[2], Amin et al^[1] studies, Patel D et al^[9]  and Kour B et al^[10]. Male preponderance may be due to vulnerablility for various diseases due to occupational exposure risk factors and also due to smoking and alcohol addiction.

In the present study, highest number of cases were seen in age group 30-50 yrs (45cases- 38.46%) which was in concordance with Patel et al^[9] (43.1%), Chauhan G et al^[6] (35.8%) and Tahir TM et al^[5] (56.3%) followed by >60 years age group (28 cases- 23.93%) which was similar to studies done by Chauhan G et al^[6] (23.9%) and Patel et al^[9] (17.8%).

In the present study, neoplastic lesions(Fig5) were 0.85%which was similar to study of Mangal et al^[4] (0.41%), sumaya et al^[7] (0.87%) , Amin NS et al^[1] (1.7%)and Chauhan G et al^[6] (2.08%).It was a case of Metastatic carcinoma deposits in lung.

The most common finding in our study  was chronic venous congestion accounting for  36 cases(30.78%),  which is in concordance with the study conducted by Chandni B. Patel^[11],  Hanmante et al^[12], Selvam et al^[13] where pulmonary edema and congestion were seen in44.4%, 21.7% and 31.5% respectively. Chronic venous congestion could be due to secondary involvement of lungs which presents as terminal events due to cardiovascular causes or a death related change. In our study, the incidence of pulmonary edema and congestion were more in cases with poisoning and sudden death.

There were 13 cases (11.11 %) of pneumonia in our study which was comparable with study of Mangal K et al^[4] , Chauhan G et al^[6] who found 7.99% and 14.62%, respectively.  Maximum number of cases in age group of >60 years were also of pneumonia. This may be attributed to high vulnerability of this age group to infectious disease and due to low immunity. Pneumonia being a most common observed pathology in our set up suggests infectious disease are still remaining to be one of the common causes of mortality. Pneumonia which is a preventable cause of death can be reduced by timely diagnosis and proper treatment.

In the present study, emphysematous (fig 6) changes were seen in 3 cases(2.56%) which is similar with  studies of Chauhan G et al^[6], Amin NS et al^[1] and Khare P et al^[14] 7.76%, 6.6% and 8.75% cases respectively

In the present study, there were 2cases (1.71%) of tuberculosis which was similar to Anisha TS etal^[2] study.

In our study ARDS cases were 13 compared to Chavi gupta  etal^[8] having 5 cases. ARDS/ diffuse alveolar damage was most common in poisoning cases and unknown cause cases.

Autopsy is an important tool useful for identifying, recognizing pathology and pathogenesis of disease regardless of recent advances in diagnostic technology. Autopsy study reveals the true prevalence of infectious diseases and also suggests the need and emphasis of timely diagnosis and treatment of these diseases to reduce mortality due to these diseases. Autopy histopathological examination of lung specimens helps to highlight many incidental findings, demonstrates underlying cause of death and also serves as scope for detection of newer diseases.

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