Forensic Pathology for Police - Brainshare Public Online Library

Respiratory System 235
Chronic Lung Disease
A variety of conditions can be considered “chronic lung diseases.” Such disorders
sometimes are referred to by other names, such as “interstitial lung diseases” or
“pneumoconiosis.” It is far beyond the scope of this text to address these disorders.
Suffice to say that there are a variety of substances that can be chronically
inhaled which lead to lung injury and compromised respiratory function, for example
coal dust, silica, and asbestos. Many of these may be considered “occupational
lung diseases,” as they are related to occupational exposure to various substances.
Some, like asbestos, are associated with an increased risk of malignancy (cancer).
Although such disorders are related to an external causative factor, they are frequently
considered “natural,” since they represent the body’s long-term response to
that environmental insult (similar to the reasoning behind considering deaths due
to chronic alcoholism or chronic drug abuse as natural deaths). Others disagree
with this certification. Certainly, the designation of “natural” in such cases does
not preclude surviving family members from pursuing civil action.
Pulmonary Hypertension
Pulmonary hypertension refers to a situation where the blood pressure within
the pulmonary arteries (and branches) is chronically elevated. Many chronic lung
diseases, including asthma, COPD, chronic interstitial diseases, etc., can cause pulmonary
hypertension. In addition, a condition referred to as “primary pulmonary
hypertension” also exists, and is more common in young women. When pulmonary
hypertension exists, it results in increased work for the right side of the heart,
which is manifest as right ventricular hypertrophy and potential right-sided heart
failure. Deaths can result from cardiac problems (arrhythmias, heart failure) or the
underlying lung pathology, or a combination of both.
Neoplasia
Benign lung tumors occur, but are relatively rare. Most lung tumors are malignant
(cancer) (Disc Image 10.45). Many represent primary malignancies (arising in the
lung), but others represent metastases (malignant growths that have spread to the
lungs from a primary cancer elsewhere in the body). In a vast majority of cases, lung
cancer is diagnosed before death occurs; however, occasional cases are diagnosed
at autopsy. These are the cases that occur within the setting of a medicolegal death
investigation system.
Sarcoidosis
Please refer to the “Multisystem Disorders” section below.