tetano
Editor, Senior Moderator
Am J Clin Pathol
. 2020 Sep 2;aqaa156.
doi: 10.1093/ajcp/aqaa156. Online ahead of print.
Forty Postmortem Examinations in COVID-19 Patients
Simona De Michele[SUP] 1 [/SUP], Yu Sun[SUP] 1 [/SUP], Mine M Yilmaz[SUP] 1 [/SUP], Igor Katsyv[SUP] 1 [/SUP], Mary Salvatore[SUP] 2 [/SUP], Amy L Dzierba[SUP] 3 [/SUP], Charles C Marboe[SUP] 1 [/SUP], Daniel Brodie[SUP] 4 [/SUP], Nina M Patel[SUP] 4 [/SUP], Christine K Garcia[SUP] 4 [/SUP], Anjali Saqi[SUP] 1 [/SUP]
Affiliations
Abstract
Objectives: Although diffuse alveolar damage, a subtype of acute lung injury (ALI), is the most common microscopic pattern in coronavirus disease 2019 (COVID-19), other pathologic patterns have been described. The aim of the study was to review autopsies from COVID-19 decedents to evaluate the spectrum of pathology and correlate the results with clinical, laboratory, and radiologic findings.
Methods: A comprehensive and quantitative review from 40 postmortem examinations was performed. The microscopic patterns were categorized as follows: "major" when present in more than 50% of cases and "novel" if rarely or not previously described and unexpected clinically.
Results: Three major pulmonary patterns were identified: ALI in 29 (73%) of 40, intravascular fibrin or platelet-rich aggregates (IFPAs) in 36 (90%) of 40, and vascular congestion and hemangiomatosis-like change (VCHL) in 20 (50%) of 40. The absence of ALI (non-ALI) was novel and seen in 11 (27%) of 40. Compared with ALI decedents, those with non-ALI had a shorter hospitalization course (P = .02), chest radiographs with no or minimal consolidation (P = .01), and no pathologically confirmed cause of death (9/11). All non-ALI had VCHL and IFPAs, and clinically most had cardiac arrest.
Conclusions: Two distinct pulmonary phenotypic patterns-ALI and non-ALI-were noted. Non-ALI represents a rarely described phenotype. The cause of death in non-ALI is most likely COVID-19 related but requires additional corroboration.
Keywords: COVID-19 autopsy series; COVID-19 lung phenotypes; COVID-19 pulmonary pathology; Coronavirus; Pulmonary pathology.
. 2020 Sep 2;aqaa156.
doi: 10.1093/ajcp/aqaa156. Online ahead of print.
Forty Postmortem Examinations in COVID-19 Patients
Simona De Michele[SUP] 1 [/SUP], Yu Sun[SUP] 1 [/SUP], Mine M Yilmaz[SUP] 1 [/SUP], Igor Katsyv[SUP] 1 [/SUP], Mary Salvatore[SUP] 2 [/SUP], Amy L Dzierba[SUP] 3 [/SUP], Charles C Marboe[SUP] 1 [/SUP], Daniel Brodie[SUP] 4 [/SUP], Nina M Patel[SUP] 4 [/SUP], Christine K Garcia[SUP] 4 [/SUP], Anjali Saqi[SUP] 1 [/SUP]
Affiliations
- PMID: 32876680
- DOI: 10.1093/ajcp/aqaa156
Abstract
Objectives: Although diffuse alveolar damage, a subtype of acute lung injury (ALI), is the most common microscopic pattern in coronavirus disease 2019 (COVID-19), other pathologic patterns have been described. The aim of the study was to review autopsies from COVID-19 decedents to evaluate the spectrum of pathology and correlate the results with clinical, laboratory, and radiologic findings.
Methods: A comprehensive and quantitative review from 40 postmortem examinations was performed. The microscopic patterns were categorized as follows: "major" when present in more than 50% of cases and "novel" if rarely or not previously described and unexpected clinically.
Results: Three major pulmonary patterns were identified: ALI in 29 (73%) of 40, intravascular fibrin or platelet-rich aggregates (IFPAs) in 36 (90%) of 40, and vascular congestion and hemangiomatosis-like change (VCHL) in 20 (50%) of 40. The absence of ALI (non-ALI) was novel and seen in 11 (27%) of 40. Compared with ALI decedents, those with non-ALI had a shorter hospitalization course (P = .02), chest radiographs with no or minimal consolidation (P = .01), and no pathologically confirmed cause of death (9/11). All non-ALI had VCHL and IFPAs, and clinically most had cardiac arrest.
Conclusions: Two distinct pulmonary phenotypic patterns-ALI and non-ALI-were noted. Non-ALI represents a rarely described phenotype. The cause of death in non-ALI is most likely COVID-19 related but requires additional corroboration.
Keywords: COVID-19 autopsy series; COVID-19 lung phenotypes; COVID-19 pulmonary pathology; Coronavirus; Pulmonary pathology.