In 2011, over 35,000 ostriches were slaughtered in the Oudtshoorn district of the Western Cape province of South Africa following the diagnosis of highly pathogenic avian influenza virus H5N2. We describe the pathology and virus distribution via immunohistochemistry in juvenile birds that died rapidly in this outbreak after showing signs of depression and weakness. Associated sialic acid (SA) receptor distribution in uninfected birds is also described. At necropsy, enlarged spleens, swollen livers, and generalized congestion were noted. Birds not succumbing to acute influenza infection often became cachectic with serous atrophy of fat, airsacculitis, and secondary infections. Necrotizing hepatitis, splenitis, and airsacculitis were prominent histopathologic findings. Virus was detected via immunohistochemistry in abundance in the liver and spleen but also in the air sac and gastrointestinal tract. Infected cells included epithelium, endothelium, macrophages, circulating leukocytes, and smooth muscle of a variety of organs and vessel walls. Analysis of SA receptor distribution in uninfected juvenile ostriches via lectin binding showed abundant expression of SAα2,3Gal (avian type) and little or no expression of SAα2,6Gal (human type) in the gastrointestinal and respiratory tracts, as well as leukocytes in the spleen and endothelial cells in all organs, which correlated with H5N2 antigen distribution in these tissues.