AIMS To describe the pathological and background features of several cases of tuberculosis diagnosed at post mortem examinations and performed on behalf of HM Coroner over a three year period in west London. METHODS Postmortem examinations were carried out by two pathologists working at hospital and public mortuaries in west London. Cases of tuberculosis were provisionally diagnosed on gross examination and the diagnosis confirmed on haematoxylin and eosin and Ziehl-Neelsen staining of retained tissues. The background information was obtained by scrutinising hospital records and by direct enquiry to general practitioners by coroners' officers. RESULTS Thirteen cases of pulmonary tuberculosis were diagnosed during the period. No other cause of death was found. The incidence of fatal pulmonary tuberculosis was 0.28% of coroners' necropsies in the study region. Cases had been referred to the coroner because death had occurred unexpectedly, or because no recent medical attention had been sought. Most cases arose among the elderly Asian immigrant population or the homeless or the alcoholic, or both. In 10 cases the macroscopic findings strongly indicated pulmonary tuberculosis and in the other three the diagnosis was considered to be a differential diagnosis. CONCLUSIONS These findings have important health implications for those carrying out post mortem examinations from these groups as well as for those involved with the continuing care of immigrant or vagrant populations.