After an extensive external examination a pathologist usually begins an autopsy with a standard "Y"- shaped incision. The short arms of the "Y" begin at the shoulders, meet at the breast and the incision continues in a straight line to the pubis. The skin is then reflected away from the chest and abdominal regions. The chest plate is exposed and removed by a saw. The pericardial sac is opened and blood is removed for toxicological studies here or in peripheral sites, such as the subclavicular or femoral vessels. The organs are then removed either en-bloc (Roki-tansky method) or individually (Virchow method).
The brain is usually removed by an assistant. An incision is made from behind one ear and then extended across the top of the head down to behind the other ear. The scalp is reflected both forwards and backwards to expose the skull. The top of the skull is removed with a saw and the brain is exposed. The brain is removed and evaluated.
There is no one "best" method of performing an autopsy. The objective is to find the answer. A complete examination is recommended because a decedent may have more than one potential cause of death. For example, a person may have died from a ruptured aneurysm of the brain, but also have had terrible heart disease. If the brain were not examined because the heart disease was felt to be the cause of death, the diagnosis would have been missed.
The pathologist samples internal organs for microscopic examination when necessary. The cause of death is usually determined at the conclusion of the autopsy, i.e., at the end of the gross examination. However, microscopic analyses sometimes aid in diagnosing the specific cause of the disease, such as the types of cancer or infection. Microscopic analysis is not necessary in most cases, especially those in which trauma was the cause of death. However, if microscopic examination is performed, a final diagnosis is not usually rendered until the slides are reviewed. Some pathologists make slides on most cases, while others do not. There is no rule as to how often or how many microscopic specimens are taken.
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