An Introduction

To Autopsy Technique
Step-by-Step
Diagrams

Kim A. Collins, MD
Grover M. Hutchins, MD
 I. EXTERNAL EXAMINATION

Identify the body.

Verify autopsy permit: validity and extent.
Weigh, measure, and inspect the body for:
- presentation
- marks of therapy
- identification
- perimortem/postmortem changes
Measure and compare leg circumferences at
10-cm intervals above the medial malleoli.
Make the primary incisions.
1. Y-incision. Stay above the anterior axillary line.
2. Knee incision.
3. Chest-only incision.
4. Abdomen-only incision

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 II. OPENING THE BODY

1. Reflect the skin flaps. Cut perpendicular to

the ribcage. Make relaxing incisions in the
peritoneum and musculature about 15 cm
above the symphysis.
2. Check for tension pneumothorax. Make a pool of
water in the axilla. Push closed clamp through
an intercostal muscle beneath the water level.
3. Release the chest plate. Cut ribs medial to
costochondral junction and the clavicle lateral to
the sternoclavicular joint, with either:
a. an oscillating saw;
b. a linoleum knife and bone shears; or
c. pruning shears (inexpensive alternative).
4. Preserve the muscle attachments to the
manubrium and head of the clavicle.
5. Detach the diaphragm from the chest plate.
Inspect surfaces and contents of the pleural spaces.

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 III. THORAX

1. Reflect chest plate and strap muscles to expose

the lower neck.
2. Blunt dissect thymic fat pad from the
pericardium. Carry reflection upward to lower
pole of thyroid. Cut the thymic vein where it
enters the innominate vein.
3. Double-clamp, divide, and reflect the innominate
vein.
4. Open pericardium and clamp edges. Inspect
pericardial surfaces and contents.
5. Extend the pericardial incision through the
pericardial reflection.
6. Isolate and ligate the carotid arteries.
7. Lift the heart cranially and draw blood samples
from the left atrium.
IN SITU EXAMINATION. Examine the heart. Elevate,
palpate, and inspect the lungs. Collect specimens
for microbiology, toxicology, etc. Take any cultures
after searing the surface.

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 IV. ABDOMEN – 1

IN SITU EXAMINATION. Inspect and palpate all

organs and surfaces. Collect specimens for
microbiology, toxicology, etc.
1. Open the greater omentum between the
stomach and colon to inspect the pancreas.
2. Locate the ligament of Treitz.
3. Make a slit through the mesentery close to the
bowel wall.
4. Ligate the bowel near the duodenal-jejunal
junction.
5. Clamp the proximal jejunum.
6. Cut across the bowel.
7. Detach the mesentery close to the bowel wall,
with either:
a. scalpel strokes perpendicular to the bowel, or
b. scissors.
8. Remove colon. Empty the bowel and cut at the
rectosigmoid junction.

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 V. ABDOMEN – 2

1. Obtain transverse sections of unopened bowel

from:
a. proximal jejunum,
b. distal ileum, and
c. sigmoid colon.
2. Open the small bowel adjacent to or within
the line of mesenteric attachment with an
enterotome.
3. Open colon and appendix along anterior taenia.
4. Carefully clean and examine the entire intestinal
mucosa by pulling the bowel between the index
and middle fingers under running water.
5. Take additional sections as needed. Lay the
serosal surface on paper towel, invert, and
float in fixative.

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 VI. PELVIC ORGANS

1. Free the male pelvic organs from the pelvic wall

by blunt finger dissection in the extraperitoneal
space.
2. Identify and cut the membranous urethra with
scissors, and transect the rectum with a knife.
3. Push the testes from the scrotum into the
inguinal canal and detach by cutting the
spermatic cord (left long).
4. Expose the shaft of the penis below the
symphysis pubis and remove a segment.
5. Free the female pelvic organs by blunt finger
dissection in the extraperitoneal space, and
transect the urethra, vagina, and rectum with
a knife.
Elevate the pelvic organs, separate any remaining
fascial attachments, and lay them back into the
pelvic cavity.

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 VII. ORGAN BLOCK REMOVAL

1. Grasp or clamp the trachea and esophagus,

and transect them.
2. Retract the thoracic and abdominal organs,
and cut the diaphragm attachments.
3. Elevate the lung and cut the pleura with a
scalpel along the lateral aspect of the vertebral
bodies.
4. Retracting the entire block, continue the pleural
cut through the crus of the diaphragm, and
extend the cut along the lateral aspects of the
lumbar vertebrae above the psoas muscle.
5. With both sides cut, elevate the thoracic viscera
and deliver the entire organ block, detaching
any remaining connections to the vertebral
column.

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 VIII. NECK ORGANS AND HEAD

1. Retract the carotid arteries, clamp the end of

the trachea, and free the neck organ block with
blunt finger dissection.
2. With a long knife, detach the neck organ block
by cutting anteriorly and medially on the inner
aspect of the mandible.
3. Reflect the lower pharynx.
4. Locate and remove the parathyroids.
5. Remove, weigh, and take sections of thyroid.
6. Cut the pharynx in the posterior midline.
7. Cut the larynx and upper trachea in the
posterior midline and crack open.
8. Cut the tongue transversely and take sections to
demonstrate the lingual tonsil.
9. Separate the hair and incise the scalp across
the vertex, beginning behind the right ear.
10. Reflect the scalp down to the hairline.
11. Incise and slightly reflect the temporalis
muscles. Cut the calvarium with an oscillating
saw. Detach the dura from the skull cap.

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 IX. REMOVAL OF BRAIN

1. Open superior longitudinal sinus.

2. Cut dura along the line of skull cut and reflect
toward the midline. Inspect the brain.
3. Retract frontal poles and cut anterior
attachments
of falx.
4. Elevate olfactory bulbs, retract brain, and cut:
a. optic nerves,
b. carotid arteries, and
c. other nerves
5. Retract brain medially and cut tentorial
attachments along the petrous ridges.
6. Retract brain posteriorly and cut remaining
cranial nerves as close to bone as possible,
vertebral arteries and spinal cord as distally as
possible within the spinal canal.
7. Retract cerebellum and brainstem. Support
brain and cut remaining dural attachment with
scissors.

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 X. BASE OF SKULL

Inspect base of skull.

1. Open dural sinuses.
2. Strip basilar dura by rolling on a large clamp.
3. Pull on skull to check for basilar fractures.
4. Take the pituitary gland; either:
a. remove a block which includes the optic
nerves, cavernous sinuses, and sella turcica
(this exposes spheroid sinus and posterior
nasopharynx), or
b. remove it from the sella turcica:
i) chisel off the posterior clinoid processes,
ii) elevate it,
iii) blunt dissect the pituitary gland from the
sella turcica, and
iv) cut the anterior dura.
5. Examine the middle ears; either:
a. open the cavity with a chisel, or
b. remove a block of petrous ridge.
6. Remove the eyes; either:
a. unroof the orbit with a chisel, or
b. incise the conjunctiva, hook the eye muscles,
and cut muscles and optic nerve with
scissors.

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 XI. SPINAL CORD AND NERVES

1. Remove the psoas muscles.

2. With the oscillating saw, expose the spinal cord
between L5-S1 and C3-C4 discs.
a. In the lumbar region, cut the pedicles and try
to avoid injury to the cord.
b. In the thoracic area, it is helpful to use the
osteotome to expose the heads of the ribs,
and aim the saw cut toward the cord through
the neck of the rib and the pedicle of the
vertebra.
c. In the cervical region, cut through the lateral
part of the vertebral body downward into the
vertebral canal.
Beginning at the lower end, lift the vertebral column
and detach the anterior ligamentous connections to
the cord.
3. Expose all posterior ganglia and nerve roots of
interest to be removed in continuity with the
cord. Develop the sacral plexus by forcing a
finger between it and the pelvic wall. Cut sacral
roots but maintain lumbar connections. Remove
cord and attached nerves from below upward.
Free the upper cervical cord by cutting the dura
from within the foramen magnum.
4. Examine the cord by opening the dura in
the anterior and/or posterior midline or by
sectioning the cord transversely with dura
intact, usually after adequate fixation.
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 XII. BONES AND JOINTS

1. Obtain a complete section of the

sternoclavicular joint with the oscillating saw
or band saw.
2. Cut vertebral bodies into longitudinal segments
with the band saw and take specimens.
3. Section ribs longitudinally through the short
axis with the oscillating saw, and take blocks
to include the costochondral junction. Squeeze
marrow from a portion of rib (or any other bone)
for smears or tissue blocks.
4. Take bone biopsies from the iliac crest (or other
areas) with a trocar.
5. Open the knee joint, cut and reflect the extensor
tendon and patella, inspect the joint surfaces,
and take synovium or other specimens.
6. Make two parallel cuts 1 cm apart and one-third
through the femoral shaft with the oscillating
saw. Obtain a specimen of femoral marrow with
the chisel.

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 XIII. THE ORGAN BLOCK

Keep the organs anatomically arranged. Blunt

dissect as much as possible. Inspect, document,
and sample. Modify technique as needed. Clean up
as you go.
1. From the posterior aspect, identify and open the
thoracic duct and cisterna chyli.
2. Open the aorta from the left subclavian to the
left external iliac artery in the posterior midline.
3. Rotate and retract the left lung. Open the aortic
arch and its branches on their left aspect.
4. Transect the aorta.
5. Reflect the aorta and esophagus downward.
6. Separate the heart-lung block by cutting
the pericardium from the diaphragm and
transecting the inferior vena cava.

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 XIV. SEPARATING THE KIDNEY
AND LIVER BLOCKS

1. From the posterior aspect, reflect the right leaf

of the diaphragm.
2. Transect the inferior vena cava.
3. Blunt dissect the right adrenal from its bed and
detach, weigh, section, inspect, and sample it.
4. Retract the right kidney posteriorly.
5. Reflect the left leaf of the diaphragm.
6. Pull the esophagus through the hiatus.
7. Detach, inspect, and sample the diaphragm.
8. Treat the left adrenal and kidney as the right.
9. Transect the inferior vena cava just below its
attachment to the liver.
10. Open the hepatic segment of the inferior vena
cava and inspect the hepatic veins.
11. Identify and transect the celiac axis and superior
mesenteric artery close to the aorta.
12. Grasp the aorta and inferior vena cava, and pull
the kidney block from the liver block, breaking
the few remaining connections.

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 XV. THE LIVER BLOCK – 1

From the Posterior Aspect

1. Open the celiac axis and its branches.
2. Open the superior mesenteric artery and its
branches.
3. Open the posterior midline of the portal vein and
its hilar branches.
4. Open the splenic vein to the hilum.
5. Rotate the mesentery.
6. Open the superior mesenteric vein and branches.
From the Anterior Aspect
7. Rotate the liver up and back to expose its hilum.
8. Open the esophagus, stomach, and duodenum
following the greater curvatures, and inspect and
sample them.
9. Probe the common bile duct and pancreatic duct
from the ampulla of Vater.
10. Blunt dissect the gallbladder from its bed, and
open, inspect, and sample it and the extrahepatic
biliary tree.
11. Transect the duodenum and remove the stomach
and esophagus.
12. Open any remaining branches of extrahepatic
arteries and veins.
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 XVI. THE LIVER BLOCK – 2

1. Grasp the pedicle of the liver, and section the

liver along its longest axis on either side of
the hilum.
2. “Breadloaf” the detached parts of the liver, and
inspect and sample them.
3. Using a towel for protection, grasp the pancreas
from behind, “breadloaf” it, and inspect and
sample it.
4. Section the spleen in the same manner as the
liver, “breadloaf” the parts removed, and inspect
and sample them.
5. Section, inspect, and sample the hilar,
peripancreatic, and mesenteric lymph nodes.

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 XVII. THE KIDNEY BLOCK

1. From the anterior aspect and avoiding the

ureter, open the inferior vena cava, renal veins,
and right iliac veins.
2. Rotate the lower block and open the remaining
iliac veins.
3. Open the remaining iliac arterial branches.
4. From the posterior aspect, open the renal
arteries.
5. Weigh the kidneys and bisect them so as to
remove the posterior halves.
6. Open the collecting systems and the ureters
down to the bladder.
7. Strip the capsule from the anterior half of each
kidney.
8. “Breadloaf,” inspect, and sample the posterior
halves of the kidneys.

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 XVIII. THE PELVIC ORGANS

1. From the posterior aspect, open the rectum in

the posterior midline and inspect it.
2. Reflect the rectum from the other pelvic organs
by blunt and sharp dissection, beginning at the
anal end, and clean, inspect, and sample it.
3. From the anterior aspect, open the bladder from
the apex toward, but not into, the urethra, and
inspect and sample it.
Male
4. From the posterior aspect, “breadloaf” the
prostate, leaving the slices attached by the
anterior capsule, and inspect and sample them.
5. “Breadloaf” the seminal vesicles across their
long axes, and inspect and sample them.
Female
6. From the posterior aspect, cut the lateral
aspects of the vagina, cervix, and uterus, and
inspect and sample them.
7. “Breadloaf” the ovaries and fallopian tubes
across their long axes, and inspect and sample
them.

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 XIX. SEPARATING THE HEART
AND LUNGS

1. From the anterior aspect, rotate the lungs

laterally and under to expose the mediastinum.
2. Open the pulmonary trunk and major branches,
transecting the superior vena cava, and inspect
for emboli.
3. Transect the pulmonary artery.
4. Elevate the heart and transect the pulmonary
veins, in turn, the pericardial reflections, and
any other attachments to remove the heart.
5. Open the superior vena cava and its branches.

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 XX. THE LUNGS

Weigh the lungs.

1. From the posterior aspect, rotate the anterior
aspects of the lungs medially and under.
2. Open the trachea, mainstem bronchi, and
proximal lobar bronchi.
3. Section the lungs by placing the knife in the
notch formed at the bifurcation of the mainstem
bronchi, and slice laterally.
4. Open the intrapulmonary bronchi and vessels
exposed on the cut surfaces.
5. “Breadloaf” the detached sections and the
anterior parts of the lungs from lateral to medial,
and inspect and sample.
6. Section the carinal, peribronchial, and
paratracheal lymph nodes in the same plane
as the lung slices.

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 XXI. THE HEART

1. Identify the venae cavae and open the right

atrium.
2. Open into the right atrial appendage.
3. Detach the free wall of the right ventricle close to
the septum.
4. Continue the cut along the right ventricular outflow
tract through the pulmonary valve commissure.
5. Transect the moderator band.
6. Open the left atrium between the superior
pulmonary veins.
7. Extend the cut to the other pulmonary veins.
8. Open into the left atrial appendage.
9. Pass a knife through the mitral valve, pierce
the apex, and slice upward perpendicular to the
interventricular septum.
10. Reflect the pulmonary trunk from the aorta.
11. With scissors, cut down the aorta, through the
commissure between the two coronary cusps,
and into the myocardium.
12. Angle the scissors and cut to transect the
left anterior descending coronary artery and
myocardium.
13. Position the knife parallel to the interventricular
septum and, engaging the ends of the scissors-
cut and the apical knife-cut, slice the free wall of
the left ventricle from the septum.
14. Transect the coronary arteries at close intervals.
Inspect everything, weigh the heart, and take
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 XXII. THE PERINATAL AUTOPSY

Check for pneumothoraces with needle and syringe

at highest ventral area on right and left side of
chest before making incision. Measure amount of
pneumothorax by withdrawing air with syringe.
1. Make the primary incision so that skin ellipses
containing the breasts may be removed and
examined.
2. Encircle the umbilicus with the primary incision
so that it may be removed in continuity with the
umbilical vessels.
3. Extend the incision around the perineum so
that the external genitalia and anus remain in
continuity with the organ block.
4. Carefully cut the symphysis pubis, manually
spread the pelvic bones, and deliver the perineal
block.
5. Incise and reflect the scalp.
6. Beginning in the anterior fontanelle, incise the
dura on each side of, and close to, the superior
longitudinal sinus.
7. Reflect, without detaching, the parietal bones.
8. Cut the falx and complete the brain removal as
in the adult, but deliver the brain directly into a
container of fixative.8.

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