Long term pathological changes in lungs after COVID-19

World literature is paying increasing attention to the long-term course of COVID-19 and symptoms that appear after the acute coronavirus infection. The symptoms, functional state of the lungs, and the X-ray changes are assessed. Nevertheless, post-COVID lung histology has not been described yet. The aim of this article is to study the long-term pathological changes in the lungs after acute COVID-19. Methods. We analyzed autopsy lung material from 19 deceased who had COVID-19. The average age of the deceased was 68.82 ± 14.6 years. All patients were found to have IgG to SARS-CoV-2. The median time to death following viral interstitial pneumonia was 72 days. Results. The causes of death and thrombotic complications (infarctions of various organs and venous thrombosis) were analyzed. Histological examination revealed thrombosis of small pulmonary arteries and capillaries of interalveolar septa, microinfarctions, hemorrhages, foci of organizing pneumonia, and nonspecific interstitial pneumonia. Conclusion. The first assessment of histological changes in human lungs showed that the most common post-COVID pathologic changes are microcirculation disorders combined with small areas of acute lung damage. The obtained data are essential for understanding the pathogenesis of post-COVID syndrome, necessitate diagnostic of microvasculature disorders using laboratory tests, scintigraphy, and CT imaging, as well as search for the therapeutic strategies. © 2021 Vestnik Tomskogo Gosudarstvennogo Universiteta, Matematika i Mekhanika. All rights reserved.

Pathological Features in 100 Deceased Patients With COVID-19 in Correlation With Clinical and Laboratory Data.

Background: Autopsies on COVID-19 deceased patients have many limitations due to necessary epidemiologic and preventative measures. The ongoing pandemic has caused a significant strain on healthcare systems and is being extensively studied around the world. Clinical data does not always corelate with post-mortem findings. The goal of our study was to find pathognomonic factors associated with COVID-19 mortality in 100 post-mortem full body autopsies. Materials and Methods: Following necessary safety protocol, we performed 100 autopsies on patients who were diagnosed with COVID-19 related death. The macroscopic and microscopic pathologies were evaluated along with clinical and laboratory findings. Results: Extensive coagulopathic changes are seen throughout the bodies of diseased patients. Diffuse alveolar damage is pathognomonic of COVID-19 viral pneumonia, and is the leading cause of lethal outcome in younger patients. Extrapulmonary pathology is predominantly seen in the liver and spleen. Intravascular thrombosis is often widespread and signs of septic shock are often present. Conclusion: The described pathological manifestations of COVID-19 in deceased patients are an insight into the main mechanisms of SARS-CoV-2 associated lethal outcome. The disease bears no obvious bias in severity, but seems to be more severe in some patients, hinting at genetic or epigenetic factors at play.

Lung lesions in 4 pregnant women with severe covid-19-autopsy case

Currently, there are only scarce data on pulmonary COVID-19 lesions in pregnant women in the literature although the disease hasn't spared any country. This study aimed to provide insight into this issue. We carried out a retrospective analysis of the clinical data, autopsy, and microscopic findings in 4 pregnant women with severe COVID-19. Patients were admitted 4-5 days after COVID-19 onset with fever, dry cough, and reduced saturation. Positive SARSCoV2 nasopharyngeal swab PCRs were obtained. Chest CT revealed bilateral 'ground glass' pneumonia, CT 3-4. The women were diagnosed with severe COVID-19 requiring ALV and ECMO. They underwent emergent C-section with subsequent therapy. Patient 1, 37 y.o., 28-29 gestation weeks (GW), had comorbid conditions-obesity and arterial hypertension, died on the 11th bed-day (BD) due to pulmonary embolism. Patient 2, 31 y.o., 27 GW, developed bacterial pneumonia and acute pansinusitis with multiple organ failure resulting in death on 15th BD. Patient 3, 22 y.o., 35 GW, had ventilatorassociated pneumonia, lymphopenia, thrombocytopenia, anemia, and phlebothrombosis as COVID-19 complications. Later, she developed sepsis, which resulted in a lethal outcome (on 26th BD). Patient 4, 38 y.o., 32 GW, was diagnosed with pneumothorax on the 10th BD requiring pleural cavity drainage. The disease was complicated by bacterial pneumonia leading to respiratory failure and death (on the 30th BD). At autopsy, all four women had 'shock lungs' and diffuse alveolar damage at microscopy. Microscopic evaluation of the 1st patient's lung specimens revealed hyaline membranes corresponding to exudative DAD phase combined with proliferative DAD signs. In the 2nd case, we observed a pronounced cytopathic effect resulting in 'ugly' multinucleated cell formation, and multiple hemosiderophages in the alveolar lumens, as well as alveolar and bronchial metaplasia, confirmed by positive CK5-6 IHC staining. Third patient lung specimens demonstrated organizing viral pneumonia (with interalveolar granulation tissue, numerous interalveolar siderophages, indicating an alveolar-hemorrhagic syndrome) combined with massive bacterial pneumonia. Organizing viral pneumonia with mature interalveolar granulation tissue and sarcoid-like granulomas was diagnosed in 4 patient. Clinical and morphological analysis demonstrated that COVID-19 pneumonia features are similar for pregnant and non-pregnant patients of the same age group. The proliferative DAD phase was detected in three of 4 cases. However, of special interest is the first case, in which a combination of DAD phases was determined. At the same time, no severe obstetric complications were identified, which we associate with the timely diagnosis and prevention measures.

Pathology of COVID-19: Atlas

This Atlas is the result of the autopsies performed by the Moscow Pathology Service for the posthumous diagnosis of presentations and complications of COVID-19 in 2000 cases, the largest number of autopsies of COVID-19 cases in the world. This was accomplished because in Moscow an autopsy is performed in 100 % of fatal cases with suspected COVID-19 with a detailed clinical and morphological analysis. The results of the studies formed the basis of a new methodology that expands upon WHO Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death. Transferring this methodology into practice allowed not only to improve reporting of COVID-19-related deaths, but also had a significant impact on the management strategies of COVID-19 patients. A contribution to the theory of pathology is the introduction of the concept of clinical and morphological "masks" of COVID-19. Atlas presents a wide range of signs and complications of COVID-19, which outline ways for further study of their pathogenesis and morphogenesis, improvement of diagnostics and treatment of patients, and a detailed classification of the causes of death directly or indirectly associated with COVID-19. Atlas is intended for pathologists, forensic experts, as well as doctors of all clinical specialties and students in medical schools, including those in advanced training programs of continuing medical education.

Features of pathological anatomy of lungs at COVID-19

The research aim is to study the morphological features of COVID-19 in the lungs of patients who died in Moscow from March 20 to June 6, 2020. Methods. Autopsy material of the lungs from 123 deceased (54 women, 69 men) with COVID-19 coronavirus infection (confirmed by PCR) was analyzed, the median age was 71 (30 - 94) years, and the duration of the disease was 14 (3 - 65) days. In all cases, the patient's medical records and autopsy reports were analyzed. Macro- and microscopic changes in the lungs were evaluated in all the observations. Results. The pathology of the lungs in COVID-19 corresponds to various phases of diffuse alveolar damage (DAD). The exudative phase of DAD was detected in 54 (43.9%), the proliferative phase - in 21 (14.63%), and their combination - in 51 (41.46%) of the deceased. Histological features of different phases of DAD are described. Conclusion. An analysis of autopsy material revealed a mismatch between the duration of the course of the disease and the phase of diffuse alveolar damage. A significant portion of the dead found a combination of exudative and proliferative phases of the disease. Histological signs that indirectly indicate a violation of the coagulation system during COVID-19 are described. © 2020 Medical Education. All rights reserved.