How are high-risk autopsies performed?

Updated: May 20, 2019
  • Author: Jeffrey S Nine, MD; Chief Editor: Kim A Collins, MD, FCAP  more...
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Answer

Answer

In cases of high-risk infection, evisceration and dissection may be carried out without scalpels, and sectioning may be postponed until the dissected organs have been fixed in 10% formalin; this cannot be done, however, without compromising the autopsy investigation. If large organs such as the liver are not cut into before they are immersed in fixative, many days would be required for the formalin to penetrate to the center of the organ; during that time, autolysis will have obliterated the histology, and the provisional autopsy (PAD) report will be delayed well past the 2 working days required for College of American Pathologists (CAP) laboratory certification. Previous fixation also makes microbiologic cultures impossible.

If mycobacterial infection is discovered, polymerase chain reaction (PCR) testing may be performed on the fixed tissue to determine whether the infection is tuberculosis and, if it is tuberculosis, whether it involves a multidrug-resistant strain. However, these tests are designed for use in blood samples from living patients; they may not work on fixed autolyzed autopsy tissue.

If the presence of pulmonary tuberculosis has already been documented, the lungs may be insufflated with formalin before sectioning. If one is willing to forgo microbiologic culturing and if the local funeral directors permit it, the entire body may be embalmed before autopsy.

Potentially, a minimally invasive approach, such as external examination, toxicology, and postmortem computed tomography (CT) scanning, may provide clues to or evidence for the cause of death without the need to perform a full postmortem evaluation in high-risk cases. [12]


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