Histopathological findings in fatal COVID-19 severe acute respiratory syndrome: preliminary experience from a series of 10 Spanish patients

Abstract

In December 2019, an outbreak of severe acute respiratory syndrome associated to SARS-CoV2 was reported in Wuhan, China. To date, little is known on histopathological findings in patients infected with the new SARS-CoV2. Lung histopathology shows features of acute and organising diffuse alveolar damage. Subtle cellular inflammatory infiltrate has been found in line with the cytokine storm theory. Medium-size vessel thrombi were frequent, but capillary thrombi were not present. Despite the elevation of biochemical markers of cardiac injury, little histopathological damage could be confirmed. Viral RNA from paraffin sections was detected at least in one organ in 90% patients.

Retinal Microvascular Impairment in COVID-19 Bilateral Pneumonia Assessed by Optical Coherence Tomography Angiography

“…It is noteworthy that the prothrombotic state is clinically relevant even in patients who had received prior thromboprophylaxis [ 2 ]. In fact, microvascular endothelial injury, combined with cytokine overproduction, have been hypothesized as the key factor leading patients with severe COVID-19 to multiple organ failure [ 3 ].…”

A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia

“…No histopathological features of organized pneumonia were found in that study. The case series of Recald-Zamacona et al [ 163 ] confirmed these correlations.…”

“…Few studies have correlated imaging findings in severe cases of COVID-19 pneumonia with histopathological findings [ 162 , 163 , 164 , 165 , 166 , 167 ]. This issue was investigated especially in case reports and case series mainly based on CT features described in ante-mortem or post-mortem examinations [ 163 , 164 , 165 , 166 ].…”

“…Few studies have correlated imaging findings in severe cases of COVID-19 pneumonia with histopathological findings [ 162 , 163 , 164 , 165 , 166 , 167 ]. This issue was investigated especially in case reports and case series mainly based on CT features described in ante-mortem or post-mortem examinations [ 163 , 164 , 165 , 166 ]. CT imaging findings such as GGO and consolidations usually correspond to histopathological examinations with diffuse alveolar damage (DAD) in different stages [ 162 , 163 , 164 , 165 , 166 ].…”

“…This issue was investigated especially in case reports and case series mainly based on CT features described in ante-mortem or post-mortem examinations [ 163 , 164 , 165 , 166 ]. CT imaging findings such as GGO and consolidations usually correspond to histopathological examinations with diffuse alveolar damage (DAD) in different stages [ 162 , 163 , 164 , 165 , 166 ]. DAD is usually a nonspecific response of the lung to a multitude of injurious agents characterized by edema, endothelial and alveolar injury with hyaline membrane formation in the acute phase, and fibroblast proliferation and interstitial fibrosis in the organizing phase [ 162 , 163 ].…”