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# The autopsy: clinical and medicolegal

- Technique

An autopsy examines the body after death to find out what the person died of and which diseases they had.

Updated 2026-11-01

## Key points

- Clinical = with consent; medicolegal = ordered by the authorities, without consent.
- Underlying cause ≠ mechanism of death.
- Autolysis: postmortem cell death without inflammation.
- Sudden infant death: a diagnosis of exclusion after autopsy and death-scene investigation.
- Manner of death: natural, accident, suicide, homicide, undetermined.

## What it is

An autopsy is the complete examination of a body, outside and inside, with microscopic study of the organs and, when needed, toxicology and microbiology. A clinical autopsy clarifies the disease and cause of death of a hospital patient and needs the family's consent; a medicolegal autopsy is ordered by the authorities for violent, sudden or suspicious deaths. It remains the best way to find diagnoses that were missed in life.

## Key facts

- Underlying cause of death: the disease that started the chain of events (for example, coronary atherosclerosis); it is the one statistics count.
- Mechanism of death: the final physiological derangement (for example, arrhythmia); it does not replace the cause.
- Manner of death (medicolegal): natural, accident, suicide, homicide or undetermined.
- Postmortem changes: livor mortis (blood settling by gravity), rigor mortis and algor mortis (cooling).
- Postmortem autolysis destroys cells without an inflammatory reaction; necrosis in life has one.
- Minimally invasive autopsy: needle sampling of key organs; useful where a full autopsy is not possible.

## Step by step

- The clinical record and the circumstances of death are reviewed.
- External examination: identification, injuries, signs of medical intervention and postmortem changes.
- Internal examination: evisceration and organ-by-organ study, with weights and description.
- Sampling: histology, cultures, toxicology and, if needed, genetic studies.
- Clinicopathological correlation: findings are compared with the clinical diagnoses.
- Final report with the underlying cause of death, which feeds the certificate and statistics.

## Clinical versus medicolegal autopsy

| Feature | Clinical | Medicolegal |
| --- | --- | --- |
| Who requests it | The treating doctor or the family | The legal authority |
| Consent | Required (family) | Not required |
| Cases | Natural death in hospital with diagnostic doubts | Violent, sudden unexpected, suspicious or in-custody death |
| Main question | Disease and cause of death; quality of care | Cause and manner of death; evidence for the courts |
| Who performs it | Pathologist | Forensic doctor (in Colombia, the national forensic institute) |

## Clinical notes

- Sudden infant death syndrome is a diagnosis of exclusion that requires a full autopsy and review of the death scene and clinical history.
- A sudden death in a young person may reveal hypertrophic cardiomyopathy or another inherited disease; the finding protects the family.
- Autopsy rates are falling in many countries, although autopsies still find major diagnoses unsuspected in life.

## Memory aid

The cause opens the story, the mechanism closes it: the underlying cause is chapter one, the mechanism the last page.

## Test yourself

Think of the answer, then tap the question to see it.

## Which type of autopsy does not need the family's consent?

The medicolegal autopsy, ordered by the authorities in violent, sudden unexpected or suspicious deaths.

## How is postmortem autolysis told apart from necrosis that occurred in life?

Autolysis has no inflammatory reaction; necrosis in life draws neutrophils and other inflammatory cells.

## What does a diagnosis of sudden infant death syndrome require?

A full autopsy and review of the death scene and clinical history that find no other cause.

## What is the difference between the underlying cause and the mechanism of death?

The underlying cause is the disease that started the chain; the mechanism is the final derangement, such as an arrhythmia.

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## Related

- [Sudden infant death syndrome: what is known](https://durgical.com/en/general-pathology/sudden-infant-death-syndrome-what-is-known/)
- [Infarction: red vs white, and what decides the damage](https://durgical.com/en/general-pathology/infarction-red-vs-white-and-what-decides-the-damage/)
- [Patterns of necrosis: coagulative, liquefactive, caseous, fat, fibrinoid, gangrenous](https://durgical.com/en/general-pathology/patterns-of-necrosis-coagulative-liquefactive-caseous-fat-fibrinoid-gangrenous/)
- [Pulmonary thromboembolism: where it comes from and what it does](https://durgical.com/en/general-pathology/pulmonary-thromboembolism-where-it-comes-from-and-what-it-does/)
- [Mechanical and electrical injury: abrasion, contusion, laceration, wounds](https://durgical.com/en/general-pathology/mechanical-and-electrical-injury-abrasion-contusion-laceration-wounds/)
- [From specimen to report: fixation, margins and the pathology report](https://durgical.com/en/general-pathology/from-specimen-to-report-fixation-margins-and-the-pathology-report/)

## Related conditions

- [Sudden infant death syndrome (SIDS)](https://durgical.com/en/conditions/sudden-infant-death-syndrome/)
- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)
- [Aortic dissection](https://durgical.com/en/conditions/aortic-dissection/)
- [Hypertrophic cardiomyopathy](https://durgical.com/en/conditions/hypertrophic-cardiomyopathy/)
- [Drowning](https://durgical.com/en/conditions/drowning/)
- [Sepsis and septic shock](https://durgical.com/en/conditions/sepsis-and-septic-shock/)
- [Tuberculosis](https://durgical.com/en/conditions/tuberculosis/)

## Elsewhere in DurgiPedia

- [Cell injury, apoptosis and necrosis](https://durgical.com/en/histology/cell-injury-apoptosis-and-necrosis/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Pathological Methods Applied to the Investigation of Causes of Death in Developing Countries: Minimally Invasive Autopsy Approach](https://pmc.ncbi.nlm.nih.gov/articles/PMC4488344/) (PLoS One (PMC), 2015); [Sudden infant death syndrome: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001566.htm) (MedlinePlus, US National Library of Medicine, 2024); [About SUID and SIDS | SUID and SIDS | CDC](https://www.cdc.gov/sudden-infant-death/about/index.html) (Centers for Disease Control and Prevention, 2024).

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