What Do the Lungs of Influenza Look Like At Autopsy? (Friday Forensics 3-7-25)

FREE POST TODAY (but consider subscribing to paid posts to see content like this)

This week’s Friday Forensics will actually be a FREE educational post regarding influenza deaths and what the lungs look like at autopsy. There will be no quiz/case discussions because I think everyone should get a chance to see this.

Intro and Warning ⚠️ Video:

Okay, this is your last chance to scroll away before I show these lungs that I took out at autopsy…

Image 1: Right and Left Lungs (scale in cm).

As you can see these lungs have a variegated appearance, which means there are different colors and patterns. Healthy lungs that are not inflamed or otherwise damaged have a smooth, bubble gum pink appearance. As you can see these lungs have areas of bright red, which come from the inflammation induced by the virus as well as blood leaking out of damaged blood vessels.

Image 2: Close up of Right Lung

The yellow asterisk marks the only ‘normal appearing’ area of this lung. In other words, if this lung were entirely healthy the surface appearance would look like this area; smooth, glistening, and light pink in color.

One thing to note here is that this appearance is not necessarily specific for influenza but rather the appearance of severe lower respiratory infections. COVID, RSV, (perhaps even hantavirus?) and many others could give the lung this appearance. I chose influenza in part because we are seeing so much of it this year and because prior to this year it’s pretty unusual to see an unexpected flu death (in other words, usually if someone dies of the flu the diagnosis is known, they are hospitalized, and therefore an autopsy is not needed). So, I never really had much opportunity to take these educational photos.

This patient had a coagulopathy, meaning the blood was not clotting properly, and this probably contributed to the excess bleeding seen in this case.

In any year of my career prior to this the maximum amount of flu deaths I had at autopsy was 2. This year I am at 7 as of Feb 28. Stay safe. Consider your own risk. Avoid densely crowded indoor spaces. Mask if necessary. Stay home if sick and if you are in a position of management, encourage sick employees to stay home if possible. Consult your doctor on whether or not you should get a flu shot.

Thank you for participating in this case. If you are interested in content like this, please consider subscribing, as I usually try to put autopsy-related photos and case discussions behind a paywall (largely because I get angry messages if gruesome photos are in the public feed). Remember, this is all about education. That’s why I do this.

—DLW