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This how-to guide presents today's most complete coverage of performing, interpreting, and reporting post-mortem examinations. In addition to discussing the basics of the specialty, this lasting and useful reference features information on the performance of specialized autopsy procedures. The material is divided into two sections for ease of use: a manual covering specific autopsy procedures, biosafety, generation of autopsy reports, preparation of death certificates, and other essential subjects; and an atlas, organized by organ system, that captures the appearance of the complete spectrum of autopsy findings. The updated second edition features a new chapter on the popular topic of forensic pathology.
  • Focuses on hospital autopsy, while also providing a brief introduction to forensic autopsy.
  • Examines autopsy photography and radiology, microscopic examination, supplemental laboratory studies, and other investigative approaches.
  • Includes a chapter on performing special dissection procedures that are usually not covered during a typical residency.
  • Presents over 590 full-color photographs depicting common gross and microscopic autopsy findings for every part of the body.
  • Correlates pathologic findings with their clinical causes to enhance diagnostic accuracy.
  • Covers the hot topic of forensic pathology in a new chapter introducing the subspecialty.
  • Addresses the latest legal, social, and ethical issues as well as quality improvement and quality assurance.
  • Features improved images in the Atlas section to give an even more useful visual reference.



Publié par
Date de parution 17 février 2009
Nombre de lectures 4
EAN13 9781437719710
Langue English
Poids de l'ouvrage 6 Mo

Informations légales : prix de location à la page 0,0752€. Cette information est donnée uniquement à titre indicatif conformément à la législation en vigueur.


Autopsy Pathology
A Manual and Atlas
Second Edition

Walter E. Finkbeiner, MD, PhD
Professor and Vice Chair, Department of Pathology, University of California, San Francisco
Chief, Department of Pathology, San Francisco General Hospital, San Francisco, California

Philip C. Ursell, MD
Professor, Department of Pathology, University of California, San Francisco
Director, Autopsy Service, Moffitt-Long Hospital, San Francisco, California

Richard L. Davis, MD
Professor Emeritus, Department of Pathology, University of California, San Francisco, California

Andrew J. Connolly, MD, PhD
Associate Professor, Department of Pathology, Stanford University Medical Center, Stanford, California
Elsevier Inc., 2009
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: You may also complete your request on-line via the Elsevier website at .

Neither the Publisher nor the authors assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient.
The Publisher
Library of Congress Cataloging-in-Publication Data
Finkbeiner, Walter E.
Autopsy pathology: a manual and atlas / Walter E. Finkbeiner, Philip
C. Ursell, Richard L. Davis; contributor, Andrew J. Connolly—2nd ed.
p.; cm.
Includes bibliographical references and index.
ISBN 978-1-4160-5453-5
1. Autopsy—Handbooks, manuals, etc. 2. Autopsy—Atlases. I. Ursell,
Philip C. II. Davis, Richard L., M.D. III. Title.
[DNLM: 1. Autopsy—methods. 2. Death Certificates. 3. Quality
Control. QZ 35 F499a 2009]
RA1063.4.F566 2009
Acquisitions Editor: Bill Schmitt
Developmental Editor: Andrea Vosburgh
Project Manager: Mary Stermel
Designer: Gene Harris
Marketing Manager: Brenna Christensen
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To our students

Walter E. Finkbeiner, MD, PhD, Philip C. Ursell, MD, Richard L. Davis, MD
The authors are gratified that the first edition of Autopsy Pathology was well received. Our objective in publishing a second edition remains the same as before, namely to provide a resource for those learning the art and science of postmortem examinations. Though the book is designed with the pathologist-in-training in mind, we hope that practicing pathologists, pathology assistants, and others involved in various fields of death investigation will also find it useful. The format used in the first edition remains; however, we have strived to improve each chapter. We have added illustrations to the atlas ( Chapter 15 ), including a new section on forensic pathology. Dr. Andrew J. Connolly of Stanford University has contributed a succinct new chapter that covers autopsy practice in cases of sepsis and multiorgan failure, a much needed addition to a modern autopsy text.
A number of individuals require acknowledgment. The support and encouragement of Dr. Abul K. Abbas, chair of the UCSF Department of Pathology, is sincerely appreciated. Special thanks are owed to Dr. Connolly for his participation in this edition. We are indebted to Dr. Mark A. Super of the Sacramento County Coroner’s Office and Drs. Robert Anthony and Gregory Reiber of Northern California Forensic Pathology for donating key forensic images. We thank Dr. Jonathan L. Hecht of the Beth Israel Deaconess Medical Center and Harvard Medical School for allowing us to use a slightly modified version of his template for fetal examinations. Our gratitude also goes to the Elsevier staff. Here, we must single out Ms. Andrea M. Vosburgh, developmental editor, for her singular attention to detail and many insightful suggestions that turned a manuscript into a book. Without her help, the task of revising this work would certainly have been much more difficult. Our thanks go also to our executive editor, Mr. William Schmitt, who provided guidance through each phase of the project. We are also indebted to Megan Greiner, production editor at Graphic World Inc. for her excellent work during final production. Finally, the authors thank their families for their enduring love and support.
Table of Contents
Chapter 1: The Autopsy—Past and Present
Chapter 2: Legal, Social, and Ethical Issues
Chapter 3: Autopsy Biosafety
Chapter 4: Basic Postmortem Examination
Chapter 5: Postmortem Examination of Fetuses and Infants
Chapter 6: Special Dissection Procedures
Chapter 7: Autopsy Photography and Radiology
Chapter 8: Microscopic Examination
Chapter 9: Supplemental Laboratory Studies
Chapter 10: The Autopsy Report
Chapter 11: Postmortem Examination in Cases of Sudden Death Due to Natural Causes
Chapter 12: Postmortem Examination in Cases of Sepsis or Multiple Organ Dysfunction
Chapter 13: Death Certification
Chapter 14: Medical Quality Improvement and Quality Assurance of the Autopsy
Chapter 15: Atlas of Autopsy Pathology
Description of Gross Autopsy Findings
Measures, Weights, and Assessment of Growth and Development
Chapter 1 The Autopsy—Past and Present

“Despite the disparagement of the ignorant and the patronizing smiles of the sophisticated, the necropsy still moves along at its time-honored, steady pace, maintaining standards, contributing to knowledge and even, on occasion, stimulating the sluggard.”
Edward A. Gall 1

The history of the autopsy is intimately connected with that of anatomy and medicine in general. According to the Egyptian historian Manetho, the king-physician Athotis (about 4000 bc ) wrote books on medicine, the first of which contained some anatomic descriptions. 2 However, most scholars believe that early anatomic descriptions came primarily from the observations of animal anatomy made by early hunters, butchers, and cooks. 3 , 4 King and Meehan, 5 in their excellent discourse on the origins of the autopsy, trace human knowledge of anatomy to the practice of haruspicy—the inspection of animal entrails, particularly the liver, to predict the future. This form of divination was widespread in the ancient world, performed at least as early as the fourth century bc in Babylonia. Later, the ancient Hebrews contributed more practical observations. Following the Talmudic law “Thou shalt not eat anything that dyeth of itself,” rabbis examined slaughtered animals for evidence of disease, especially in the lungs, meninges, and pericardium. 5
Anatomic study of human disease evolved slowly, however. In ancient Egypt, there was considerable interest in the relationship of wounds and fractures to anatomy but little concern with the effects of nontraumatic disease. The embalmers of ancient Egypt removed the internal organs through small incisions, but their observations were neither recorded nor related to diseases. Egyptian records dating from the seventeeth (Edwin Smith Papyrus) and sixteenth (Papyrus Ebers) centuries bc dealt with surgical and medical diseases but related changes to magic rather than pathologic anatomy. 2 Similar beliefs were held by the Assyrians and Babylonians. 6 In ancient India, Susruta (circa 600 bc ) advocated human dissections, but despite relatively sophisticated contemporary surgical techniques, anatomic studies (with the exception of osteology) were rather limited. 7 Practice of medicine in China and Japan was generally based on philosophy and religion rather than science, though during the Warring States Period (457-421 bc ) and in ancient texts there are references to examination of injuries. 8 - 10 However, dissection was forbidden, and anatomic knowledge remained largely speculative, based on rare dissected bodies. 2 The first recorded anatomic dissection of a human body in China occurred in 16 ad. 11 The first known dissection in Japan was in 456 ad when an autopsy done on the body of Princess Takukete following her suicide revealed fluid in the abdomen with a “stone.” 12
The humoral theories of disease that dominated ancient Greek medicine provided an atmosphere that discouraged investigation to correlate anatomy with disease. The Hippocratic physicians described external manifestations of disease—infections, abscesses, and ulcerating and even infiltrating cancers—but were content to observe human anatomy only through wounds. It is likely that no human dissections were performed in Greece until the third century bc . 13 Nevertheless, Aristotle (384-322 bc ) inspired the study of animal anatomy and development. Aristotle’s sphere of in

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