10. Coronary Vessels. Walls should be uniformly delicate and thin, and the intima should be delicate, gray and transparent. Note contents of arteries and veins. Examine arteries especially for thrombi, emboli, arteriosclerosis, atheroma, calcification, obliteration of lumen, thickening of wall, loss of elasticity, opacity of intima and increased tortuosity of course.
The most important pathologic conditions of the heart are:—endocarditis (ulcerosa, maligna, verrucosa, simplex, chronica fibrosa, sclerosing), valvular insufficiency and stenosis, hypertrophy, dilatation, atrophy, fatty infiltration, fatty degeneration, cloudy swelling, anæmic infarction, calcification, acute and chronic myocarditis, abscess, fibroid heart, cardiac aneurism, rupture, thrombosis, embolism, malformations (septum defects, patent ductus arteriosus, stenosis or atresia of orifices), tuberculosis (not rare, in association with tuberculous pericarditis, or general miliary tuberculosis), syphilis (gumma not common, localized or diffuse interstitial myocarditis the most common manifestation), actinomycosis, cysticercus, echinococcus, trichina and neoplasms (primary rare, in part congenital, fibroma, lipoma, angioma, myxoma, rhabdomyoma; secondary sarcoma less rare than secondary carcinoma, most common forms are melanotic sarcoma and lymphosarcoma).
11. Left Lung. Weighs 350-500 grm. Size (voluminous, collapsed, compare lobes); form (edges rounded, sharp, nodular, saccular or cystic, contractions, depressions, emphysematous enlargements); pleura (examine again more closely. Circumscribed dull-shining or cloudy areas point to some pathologic condition of the lung beneath. Look for evidences of healed tuberculosis, particularly in the pleura of the apices. Secondary carcinoma of the pleura is very common. Primary tumors are rare; endothelioma and sarcoma are the most common forms. Small circumscribed areas of pigmentation usually represent old tubercles); color (depends upon degree of anthracosis, blood-content and condition of pleura, areas showing especial color should be examined closely; most common colors are pinkish-gray normally, grayish, slaty, black, red, brown, dark-red to black); size of air-cells (normally can be seen with naked eye, best seen at apex and borders, about size of pin-points, when larger than the head of a pin they are emphysematous); lobules can also be seen with naked eye, usually polygonal in shape, 2-3 mm. in diameter; consistence (estimate by going over entire lung, pressing the lung-substance between thumb and fingers; air-containing lung is soft, elastic and crepitates; airless areas are hard, firm and do not crepitate).
On the cut surface the following points should be noted: Blood-content (anæmia, hyperæmia, hypostatic congestion), color of cut-surface, air-content, exudate (serous, purulent), consistence (hard, soft, elastic, caseous, brittle, crumbling), character of surface (smooth, granular, nodular, cavities). Cavities should be described according to their position, size, shape, contents and character of their walls.
12. Right Lung. Weight 420-620 grms. Note size, form, color, surface, size of air-cells, lobules, consistence, blood-content, air-content, exudate, consistence and character of cut-surface, as in case of left lung.
Evidences of healed tuberculosis are found in practically all adult lungs in the form of localized thickenings or puckering of the pleura, especially at the apices, hyaline or anthracotic nodules, encapsulated, caseous or calcified tubercles. Old scars and indurations are firm, hard and usually black in color. Caseous areas are smooth, dry, white or grayish, and opaque. Very young tubercles are elevated, grayish and translucent. Atelectatic areas are depressed and bluish-red in color. Areas of hepatization are red or gray, elevated, granular, crumbling, moist in early stage, dry in caseous hepatization. In bronchopneumonia the areas of hepatization are usually sharply circumscribed. Metastatic abscesses lie usually beneath the pleura, are usually multiple and distributed over both lungs. Bronchopneumonic areas are usually found in the dependent portions, particularly in right lung. An abundance of foamy, watery fluid on the cut-surface indicates œdema; when very bloody there is usually a marked stasis or beginning hepatization present. In atelectasis and fibrinous hepatization the exudate from the surface is not foamy. Emphysematous areas are white or grayish-white and are most frequently found along the borders. Large air-spaces are often found along the interlobular septa (interstitial emphysema), particularly in children following trauma, croup, whooping-cough, etc. In chronic passive congestion the lung is firmer than normal, deep-red or brownish in color. Hemorrhagic infarcts lie usually beneath the pleura, are wedge-shaped, with base toward pleura, firm, smooth on section, or granular, and when fresh are nearly black; older ones are lighter and brownish. Cavities in the lung occur in tuberculosis, embolic and primary abscesses, actinomycosis, gangrene, bronchiectasis, primary and secondary tumors, etc. Gangrenous areas have diffuse borders, are gray or greenish in color, with central softened areas, with ragged borders and stinking smell. In bronchiectatic cavities the smooth mucosa of the bronchus passes directly into the wall of the cavity. Primary carcinomata of the lungs appear as cavities having a white medullary wall, or as medullary strands running along the bronchi. Tuberculous cavities have caseous walls, are more or less encapsulated, and usually show younger tubercles in the neighborhood of the wall. Antemortem hypostasis is usually darker and firmer than postmortem, and is usually associated with inflammation (hypostatic pneumonia).
The most important pathologic conditions of the lungs are:—Anomalies (anomalous lobes common, infradiaphragmatic accessory lungs, agenesia, congenital bronchiectasis), atelectasis (fœtal, compression, obstruction, paralytic, etc.), emphysema (acute, chronic, vicarious, senile, atrophic, hypertrophic, interstitial, gangrenous), hyperæmia, stasis, brown induration, hypostasis, œdema (universal, stasis, hypostatic, atelectatic, acute, chronic, terminal), hemorrhage, hemorrhagic infarction, thrombosis, embolism, fatty embolism, pneumonia (croupous, atypical, bronchopneumonia, acute and chronic interstitial), abscess, gangrene, tuberculosis (acute miliary, caseous pneumonia, peribronchial, tuberculous bronchopneumonia, indurative, fibroid, phthisis pulmonum), syphilis (gumma, white pneumonia), actinomycosis, neoplasms (primary adenoma, lipoma, papilloma, chondroma, osteoma, sarcoma, carcinoma and teratoma are rare; metastatic sarcoma and carcinoma are common; malignant chorio-epithelioma is not infrequent), parasites (echinococcus, cysticercus, hook-worm embryos, pentastomum and distomum pulmonale).
13. Bronchi. Note size, contents, thickness of wall, color and thickness of mucosa. Normally the bronchi are empty, and the mucosa grayish-red. In pulmonary œdema they contain clear, foamy fluid; in bronchitis they may contain a mucous, mucopurulent, purulent, fibrinous, hemorrhagic or putrid exudate. In acute bronchitis the mucosa is red; in chronic bronchitis the mucosa may be red or brownish, and thickened or folded. Material from the stomach may enter the bronchi postmortem and cause a postmortem digestion of the mucosa or wall.
The most important pathologic conditions of the bronchi are:—Inflammation (acute and chronic catarrhal bronchitis, fibrinous, putrid, atrophic, obliterans), bronchial asthma, tuberculosis, syphilis, stenosis, bronchiectasis, perforation (aneurisms, abscess, carcinoma, tubercles, etc.), bronchial calculi, foreign bodies, neoplasms (adenoma, papilloma, carcinoma, chondroma, osteoma), parasites (cysticercus, echinococcus, hook-worm embryos, distomum pulmonale, pentastomum).
14. Bronchial Glands. Note size, pigmentation (gray, dark-gray, black), consistence, character of cut-surface, caseation, fibroid induration, calcification, œdema, congestion, abscess, neoplasm. Tuberculosis and secondary neoplasms are the most common conditions. Lymphosarcoma is the most frequent primary tumor.