tetano
Editor, Senior Moderator
Front Med (Lausanne)
. 2022 Apr 19;9:820661.
doi: 10.3389/fmed.2022.820661. eCollection 2022.
Radio-Histological Correlation of Lung Features in Severe COVID-19 Through CT-Scan and Lung Ultrasound Evaluation
Pere Trias-Sabrià[SUP] 1 2 [/SUP], Eduard Dorca Duch[SUP] 3 [/SUP], Maria Molina-Molina[SUP] 1 2 [/SUP], Samantha Aso[SUP] 1 [/SUP], Marta Díez-Ferrer[SUP] 1 [/SUP], Alfredo Marín Muñiz[SUP] 1 [/SUP], Jaume Bordas-Martínez[SUP] 1 [/SUP], Joan Sabater[SUP] 2 4 [/SUP], Patricio Luburich[SUP] 5 [/SUP], Belén Del Rio[SUP] 5 [/SUP], Xavier Solanich[SUP] 5 [/SUP], Jordi Dorca[SUP] 1 2 [/SUP], Salud Santos[SUP] 1 2 [/SUP], Guillermo Suárez-Cuartin[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: Patients with coronavirus disease 2019 (COVID-19) can develop severe bilateral pneumonia leading to respiratory failure. Lung histological samples were scarce due to the high risk of contamination during autopsies. We aimed to correlate histological COVID-19 features with radiological findings through lung ultrasound (LU)-guided postmortem core needle biopsies (CNBs) and computerized tomography (CT) scans.
Methodology: We performed an observational prospective study, including 30 consecutive patients with severe COVID-19. The thorax was divided into 12 explorations regions to correlate LU and CT-scan features. Histological findings were also related to radiological features through CNBs.
Results: Mean age was 62.56 ± 13.27 years old, with 96.7% male patients. Postmortem LU-guided CNBs were performed in 13 patients. Thirty patients were evaluated with both thoracic LU and chest CT scan, representing a total of 279 thoracic regions explored. The most frequent LU finding was B2-lines (49.1%). The most CT-scan finding was ground-glass opacity (GGO, 29%). Pathological CT-scan findings were commonly observed when B2-lines or C-lines were identified through LU (positive predictive value, PPV, 87.1%). Twenty-five postmortem echo-guided histological samples were obtained from 12 patients. Histological samples showed diffuse alveolar damage (DAD) (75%) and chronic interstitial inflammation (25%). The observed DAD was heterogeneous, showing multiple evolving patterns of damage, including exudative (33.3%), fibrotic (33.3%), and organizing (8.3%) phases. In those patients with acute or exudative pattern, two lesions were distinguished: classic hyaline membrane; fibrin "plug" in alveolar space (acute fibrinous organizing pneumonia, AFOP). C-profile was described in 33.3% and presented histological signs of DAD and lung fibrosis. The predominant findings were collagen deposition (50%) and AFOP (50%). B2-lines were identified in 66.7%; the presence of hyaline membrane was the predominant finding (37.5%), then organizing pneumonia (12.5%) and fibrosis (37.5%). No A-lines or B1-lines were observed in these patients.
Conclusion: LU B2-lines and C-profile are predominantly identified in patients with severe COVID-19 with respiratory worsening, which correspond to different CT patterns and histological findings of DAD and lung fibrosis.
Keywords: COVID-19; biopsy; lung ultrasonography (LU); pathology; radiology.
. 2022 Apr 19;9:820661.
doi: 10.3389/fmed.2022.820661. eCollection 2022.
Radio-Histological Correlation of Lung Features in Severe COVID-19 Through CT-Scan and Lung Ultrasound Evaluation
Pere Trias-Sabrià[SUP] 1 2 [/SUP], Eduard Dorca Duch[SUP] 3 [/SUP], Maria Molina-Molina[SUP] 1 2 [/SUP], Samantha Aso[SUP] 1 [/SUP], Marta Díez-Ferrer[SUP] 1 [/SUP], Alfredo Marín Muñiz[SUP] 1 [/SUP], Jaume Bordas-Martínez[SUP] 1 [/SUP], Joan Sabater[SUP] 2 4 [/SUP], Patricio Luburich[SUP] 5 [/SUP], Belén Del Rio[SUP] 5 [/SUP], Xavier Solanich[SUP] 5 [/SUP], Jordi Dorca[SUP] 1 2 [/SUP], Salud Santos[SUP] 1 2 [/SUP], Guillermo Suárez-Cuartin[SUP] 1 2 [/SUP]
Affiliations
- PMID: 35514757
- PMCID: PMC9063463
- DOI: 10.3389/fmed.2022.820661
Abstract
Background: Patients with coronavirus disease 2019 (COVID-19) can develop severe bilateral pneumonia leading to respiratory failure. Lung histological samples were scarce due to the high risk of contamination during autopsies. We aimed to correlate histological COVID-19 features with radiological findings through lung ultrasound (LU)-guided postmortem core needle biopsies (CNBs) and computerized tomography (CT) scans.
Methodology: We performed an observational prospective study, including 30 consecutive patients with severe COVID-19. The thorax was divided into 12 explorations regions to correlate LU and CT-scan features. Histological findings were also related to radiological features through CNBs.
Results: Mean age was 62.56 ± 13.27 years old, with 96.7% male patients. Postmortem LU-guided CNBs were performed in 13 patients. Thirty patients were evaluated with both thoracic LU and chest CT scan, representing a total of 279 thoracic regions explored. The most frequent LU finding was B2-lines (49.1%). The most CT-scan finding was ground-glass opacity (GGO, 29%). Pathological CT-scan findings were commonly observed when B2-lines or C-lines were identified through LU (positive predictive value, PPV, 87.1%). Twenty-five postmortem echo-guided histological samples were obtained from 12 patients. Histological samples showed diffuse alveolar damage (DAD) (75%) and chronic interstitial inflammation (25%). The observed DAD was heterogeneous, showing multiple evolving patterns of damage, including exudative (33.3%), fibrotic (33.3%), and organizing (8.3%) phases. In those patients with acute or exudative pattern, two lesions were distinguished: classic hyaline membrane; fibrin "plug" in alveolar space (acute fibrinous organizing pneumonia, AFOP). C-profile was described in 33.3% and presented histological signs of DAD and lung fibrosis. The predominant findings were collagen deposition (50%) and AFOP (50%). B2-lines were identified in 66.7%; the presence of hyaline membrane was the predominant finding (37.5%), then organizing pneumonia (12.5%) and fibrosis (37.5%). No A-lines or B1-lines were observed in these patients.
Conclusion: LU B2-lines and C-profile are predominantly identified in patients with severe COVID-19 with respiratory worsening, which correspond to different CT patterns and histological findings of DAD and lung fibrosis.
Keywords: COVID-19; biopsy; lung ultrasonography (LU); pathology; radiology.