An autopsy report is divided into two main parts: the objective findings from the physical examination and the pathologist’s interpretation of what those findings mean. Most reports follow a predictable structure, moving from identifying information to external observations, internal organ findings, laboratory results, and finally the cause and manner of death. Once you understand what each section is doing, the document becomes much easier to navigate.
The Two Parts of Every Report
The National Association of Medical Examiners describes the autopsy report as two distinct products combined into one document. The first is a factual record of everything the pathologist observed during the examination: measurements, weights, colors, textures, injuries, and abnormalities. The second is the pathologist’s professional interpretation, where they explain what those observations mean and how the person died.
This distinction matters because the factual sections can seem overwhelming or even contradictory if you don’t realize they’re just raw observations. A description of organ congestion or fluid in the lungs, for example, isn’t necessarily the cause of death. It’s a finding. The interpretation section is where the pathologist connects the dots.
External Examination
The report typically begins with an external examination, a head-to-toe description of the body’s surface. This section documents identifying features (height, weight, hair color, tattoos, scars), clothing, and any visible injuries like wounds, bruises, or abrasions. It also records signs that help estimate how long the person had been dead before the examination.
Three terms show up in nearly every external exam. Livor mortis is a purplish-blue discoloration of the skin on the lowest parts of the body, caused by blood settling due to gravity after the heart stops. The report will note where the discoloration appears and whether it was “fixed” (permanent) or still blanchable, which helps establish whether the body was moved after death. Rigor mortis is the stiffening of muscles that sets in after death as the muscles run out of their energy supply. The report describes which muscle groups are stiff and to what degree. Algor mortis refers to the cooling of the body after death, sometimes recorded as a specific temperature.
If injuries are present, this section describes them in clinical detail: their size, shape, exact location on the body, and color. A bruise might be described as a “3 x 2 cm contusion” on a specific area, with color noted to help estimate its age. Don’t expect plain-language descriptions here. The pathologist is creating a precise physical record.
Internal Examination and Organ Weights
The internal examination is usually the longest section. It follows a system-by-system approach, describing the brain, heart, lungs, liver, kidneys, spleen, and other organs. For each organ, the pathologist records its weight, appearance, color, texture, and any abnormalities.
Organ weights are compared against reference ranges that account for the person’s sex, height, and body weight. An enlarged heart, for example, might indicate long-standing high blood pressure or heart disease. Research shows a strong positive relationship between body weight and the weight of the heart, liver, and spleen, so the pathologist considers the person’s overall size when deciding whether an organ weight is abnormal. If you see a number followed by “grams” and want to know whether it’s normal, the reference ranges used by the pathologist are based on large population studies, and any significant departure will typically be noted in the interpretation section.
This section often contains dense medical terminology. “Atherosclerosis of the coronary arteries with 75% narrowing of the left anterior descending artery” means the blood vessels feeding the heart muscle were significantly blocked by plaque buildup. “Pulmonary edema” means fluid was found in the lungs. When you encounter an unfamiliar term, focus on whether the pathologist later lists it as a contributing factor in the cause of death. Not every finding in this section is directly relevant to why the person died. Bodies accumulate conditions over a lifetime, and the internal exam captures all of them.
Microscopic Examination
Many autopsy reports include a section on microscopic (histological) findings. During the autopsy, the pathologist collects small tissue samples from major organs and later examines them under a microscope. This step looks at cells and tissue structure for abnormalities invisible to the naked eye.
Microscopic examination is most valuable when the cause of death isn’t obvious from the physical exam alone. Certain conditions, like inflammation of the heart muscle (myocarditis) or tiny blood clots in the lungs (fat embolisms), can only be diagnosed under a microscope. Research has found that organs appearing completely normal during the gross examination can still harbor significant microscopic abnormalities, particularly in the brain, lungs, heart, and liver.
When the cause of death is already clear from visible injuries, such as in cases involving gunshot wounds or severe trauma, the microscopic section tends to be brief and confirmatory. It’s still performed in many jurisdictions as standard practice, but it rarely changes the conclusion in those cases.
Toxicology Results
The toxicology section reports the results of testing blood, urine, and sometimes other body fluids for drugs, alcohol, medications, and poisons. This is often the section that takes the longest to complete. The National Association of Medical Examiners requires that 90% of toxicology testing be finished within 90 days, but many offices struggle to meet even that timeline due to limited lab capacity.
If you receive a preliminary report, the toxicology section may be missing entirely or marked as pending. This is normal. The final report will be updated once results are available. Toxicology findings are reported as concentrations in the blood (for example, milligrams per liter), and the pathologist interprets whether those levels are within a therapeutic range, elevated, or at a lethal concentration. The presence of a substance in the blood doesn’t automatically mean it caused or contributed to the death. That determination comes in the interpretation section.
Cause, Mechanism, and Manner of Death
This is the section most people turn to first, and it’s the one most easily misunderstood. It contains three related but distinct conclusions.
The cause of death is the disease, injury, or condition that set the fatal chain of events in motion. It explains why the body stopped working. Examples include gunshot wounds, cardiovascular disease, lung cancer, drowning, or drug intoxication. The cause of death is written as a sequence: Part I lists the immediate cause, then any conditions that led to it, working backward to the underlying cause. A report might list “pulmonary embolism” as the immediate cause, “deep vein thrombosis” as the next step back, and “immobilization following hip fracture” as the underlying cause.
The mechanism of death describes the physiological process that actually ended life. It explains how the body stopped working. Common mechanisms include cardiac arrhythmia (the heart beating in a fatally abnormal rhythm), exsanguination (fatal blood loss), and asphyxia (oxygen deprivation). The mechanism connects the cause of death to the moment of death.
The manner of death is a classification of the circumstances: natural, accident, suicide, homicide, or undetermined. This is the term that causes the most confusion, particularly “homicide.” In the medical examiner’s usage, homicide simply means that death resulted from the actions of another person. It does not imply criminal intent or legal guilt. That distinction belongs to the legal system. A death classified as homicide on an autopsy report can result in anything from a murder charge to a finding of justified self-defense, or no charges at all.
What “Pending” Means
It’s common for an autopsy report or death certificate to list the cause or manner of death as “pending” for weeks or months. A pending death certificate is still a legal document and can be used to verify the death, but the final conclusions haven’t been reached yet. The certifier updates the document once all test results, investigation findings, and consultations are complete.
The most common reason for a pending status is that toxicology results haven’t come back. Other reasons include waiting for microscopic tissue analysis, outside medical records, or the results of a law enforcement investigation that may affect the manner of death classification.
Diagnoses and the Final Summary
Near the end of the report, you’ll find a list of diagnoses. This is a condensed summary of every significant finding, listed in order of importance. The first diagnosis is typically the cause of death, followed by contributing conditions and then incidental findings. This section is useful as a quick reference once you’ve read through the detailed examination sections, because it tells you which of the many observations the pathologist considered significant enough to list as formal conclusions.
Getting a Copy of the Report
If you’re the next of kin, you can request the autopsy report from the medical examiner’s or coroner’s office that handled the case. Most offices provide the first copy to immediate family at no charge. Be prepared to wait: cases can take several months to close, particularly when toxicology or other specialized testing is involved. You’ll typically need to provide identification and documentation of your relationship to the deceased. Once a case is closed, the coroner’s pathology and toxicology reports are generally available for release.
If you’re reading the report and feel uncertain about a specific finding, the pathologist’s office can sometimes answer questions. For legal cases, an independent forensic pathologist can review the report and provide a second interpretation of the findings.