At autopsy of a body suspected of death from chronic starvation and neglect, the MOST specific macroscopic finding would be:

• A Pulmonary oedema with bilateral pleural effusions
• B Splenomegaly with portal hypertension
• C Brown atrophy of the heart with serous atrophy of fat around the coronary arteries and in the bone marrow ✓
• D Hepatomegaly with centrizonal necrosis

Explanation

Chronic starvation produces characteristic autopsy findings: 1) Serous (gelatinous) atrophy of all fat depots — epicardial fat, perirenal fat, bone marrow fat (replaced by gelatinous mucopolysaccharide-rich material); 2) Brown atrophy of the heart (small, dark myocardium due to lipofuscin accumulation and myofibril loss); 3) Generalised muscle wasting and atrophied viscera. These findings are in stark contrast to oedematous (kwashiorkor-like) terminal starvation. Pulmonary oedema and hepatomegaly suggest other pathological processes; splenomegaly suggests infection or portal hypertension.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.