Abstract Background: Respiratory diseases contribute significantly to global mortality, particularly in low- and middle-income countries. Despite diagnostic advances, autopsy remains indispensable in uncovering the complete spectrum of pulmonary lesions, especially those missed or undiagnosed ante-mortem. Aim: To study the histopathological spectrum of lung lesions in autopsy cases at SMS Medical College, Jaipur. Materials and Methods: This observational study analyzed 698 autopsy lung specimens using H\&E staining to identify histopathological patterns. Data were statistically analyzed to assess associations with clinical parameters and causes of death. Results: Lung congestion (90.83%) and pulmonary edema (34.96%) were the most common histopathological findings. Spongy consistency was the predominant gross feature. No malignancies were identified. Age and gender showed distributional variations. Conclusion: This study analyzed 698 lung autopsy specimens and found congestion (90.83%) and pulmonary edema (34.96%) as the most common lesions. Most cases were in males aged 30–39 years. Findings highlight the significance of autopsy in identifying undiagnosed lung pathologies and terminal events like edema, infection, and inflammation. Lung autopsies revealed congestion and oedema as most common findings, emphasizing their role in understanding respiratory-related deaths.