ARDS remains a major problem in critically ill patients. Despite substantial progress in our understanding of ARDS pathophysiology, mortality rate remains high at 40-46%. Many cases of ARDS may remain undiagnosed at the time of hospital admission, and even during the course of hospital stay. While conducting medico legal autopsy we often come across cases where the deceased had been suffering from one of the known risk factors for ARDS, but the condition remained undiagnosed clinically. As a matter of fact, very few summaries of the dead persons mention the clinical diagnosis of ARDS in such instances. Recent retrospective data indicates that, in more than 25% cases the exact cause of death can be established by doing complete post-mortem examination and histopathology. An autopsy in cases with risk factors for ARDS will help in the diagnosis and better understanding of the condition.