Histopathological Insights into Pulmonary Hemorrhages: Enhancing Forensic Diagnoses.

Abstract: Pulmonary hemorrhage is a pathological condition characterized by bleeding within the lung parenchyma, ranging from localized microbleeds to extensive hemorrhagic events that significantly compromise respiratory function. The etiology of pulmonary hemorrhage encompasses multiple clinical and forensic contexts. For forensic pathologists, the most significant pulmonary hemorrhages occur in cases involving traumatic incidents, asphyxiation, narcotic substance use and resuscitation procedures. This study aims to analyze the histopathological features of pulmonary hemorrhages in a forensic context, highlighting the specific histopathological characteristics. The authors analyzed cases of pulmonary hemorrhages taken from sectoral case studies from the Forensic Department of Legal Medicine at the University of Foggia, spanning from 2019 to 2024. In all these cases the histological investigation was important for identifying the cause of death and for characterizing the lung damage, even in the absence of macroscopic contusions. In cases of asphyxia, ingestion of narcotic substances, and post-resuscitation, the edematous component prevails over the hemorrhagic component. The hemorrhagic component is evident in cases of trauma to the lung and airways, such as in chest compression or lung injury. These histopathological distinctions are pivotal for forensic pathologists as they provide concrete evidence that supports differential diagnoses, helping to clarify the cause of death in complex cases where circumstantial and autopsy data alone may not be conclusive.