The decedent was a 70 year old man with obesity, diabetes mellitus type II, history of  heavy tobacco use who complained of shortness of breath.  He went to a local clinic and was reported to have a positive covid-19 result.  The next day he suffered a witnessed collapse and died.  At autopsy, he had severe multivessel atherosclerotic disease of his coronary arteries and cerebrovascular system as well as severe aortic arteriosclerosis.  Examination of the lungs revealed moderate pulmonary fibrosis, chronic bronchitis, and acute pulmonary edema with hemorrhage.  An ..read more

This is from a middle-aged woman who died of fentanyl intoxication.  At autopsy, he had a zillion little capsular nodules on the liver, all less than 2mm.  I didn’t think much about it at the time.  Subcapsular nodules are a dime a dozen around here, and they are almost all just acellular fibrotic nodules without any diagnostic features.  I usually take a section just to see if I can find a few Histoplasmosis with GMS stain.  I’ve never seen AFB in one since I’ve been doing this (in contrast to lung nodules), but I do an AFB too, just in case.   Since they ar ..read more

Here is an interesting case of a gunshot wound with mildly unusual residue.  This is a young man who shot himself in the chest through a pillow with a handgun.  A suicide note and paperwork for disposition of belongings were present at the scene.  Soot was noted on the pillow, but none on the wound.  However, the wound did contain textile fibers consistent with pillow contents.  Here’s a picture:     Here’s a close-up of a portion of the wound, showing the fibers:   Here’s a picture of the pillow: It’s always useful to look for things that correlate w ..read more

This is a case of a man shot multiple times.  On external examination, one of the wounds looked suspiciously like a stab wound, which changed the complexion of the case a bit.   Here’s the orientation view of the injury: Here’s a close-up:   As you can see, it looks very much like a double-edged blade wound.  However, on internal examination, there was an obvious wound path between a gunshot entrance wound on the other side of the body and this exit wound, and the number of entrances, exits, and retained projectiles all added up nicely.  We’ve all been taught th ..read more

A young adult male with a long history of poorly controlled type I diabetes mellitus died of diabetic ketoacidosis.   The histology of his pancreas is characteristic of a victim of this disease. First, it may be useful to review the structure of a normal pancreas.  The normal pancreas consists of two large parts.  The first is the “exocrine pancreas” that secretes digestive enzymes into the gut.  The second is the “endocrine pancreas” that secretes numerous hormones into the blood, including insulin, proinsulin, amylin, C-peptide, somatostatin, pancreatic polypeptide ..read more

This is the case of a young adult male who jumped approximately 150 feet off of a cliff into deep water at an old flooded quarry on a dare.  The jump was recorded by a number of his companions on their cellphones.  He hit the water and surfaced unconscious.  His body was recovered a couple of hours later by law enforcement. At autopsy, there were large contusions of the lungs including a cavitating hematoma of the base of the right lower lobe, containing about 500 grams of liquid and clotted blood.  In addition, there were small contusions of the liver and superficial lacer ..read more

For the first few years I did digital photomicrograpy, I used a Nikon D90.  A couple of years ago, I bought a Nikon Z7.   I thought it might be interesting to compare the results using the same slide.  Note that the light tubes are different for the D90 and Z7, so the resulting magnification is a little different.  Thus the fields are not *exactly* the same.  Nonetheless, the difference is pretty obvious.  Also, the D90 takes a nominal 12 MP image (4288×2848) while the Z7 takes a 40 MP image (8256 x 5504).    These are pictures of a random lung fiel ..read more

This is a case of cosleeping-related mechanical asphyxia where the parents awoke to find the child wedged between the bed and the wall.  The infant was transported to a local hospital and was pronounced dead about 12 hours after admission. One of the more interesting findings is this section of the heart that shows  signs of early necrosis in the central area of the interventricular septum.  The subendocardium is spared.  I’ve seen this a few times, all in infants.    Since this child was very small, I was able to get a section through the entire interventricular ..read more

I know we’ve all seen this a thousand times, but I’m adding these images just in case someone needs it for a lecture.  These are sections of lungs from a chronic intravenous drug user, showing deposition of birefringent debris in vascular and alveolar walls.  This case is like most I’ve seen.  While in some cases there are frank granulomata, most of the time I seen the particles simply engulfed by macrophages, with a few of them being multinuclear.  I see microgranulomata occasionally and frank granulomata uncommonly.  A mistake I’ve seen some folk make is to call debr ..read more

Here are a couple of simple photomics of lipid emboli in the lungs.  This is from a case of a young adult woman who died of methamphetamine and fentanyl intoxication. She was provided resuscitative efforts for about 30 minutes, including a mechanical resuscitator.   At autopsy, she had small fractures of ribs 3-6 anterolaterally on the left. On histologic examination of the lungs. numerous small arteries contained small clear vacuoles.  These are characteristic of small lipid droplets that are leaked into the blood when a bone breaks.  Sometimes (but not this time), si ..read more