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Introduction/Objective Since the emergence of a novel SARS-CoV-2 virus caused coronavirus disease 2019 (COVID-19), a great number of autopsy studies have been published. However, histopathologic studies focused on pulmonary barotrauma are very rare. Here we report an autopsy confined to the lungs on a young COVID-19 patient. Methods/Case Report The patient was a 37-year-old male, non-smoker, with no significant past medical history, and a body mass index of 24.1, who presented with shortness of breath and cough. A computerized tomography (CT) showed features of atypical pneumonia. The main abnormal laboratory data included elevated partial thromboplastin time, fibrinogen, and D-Dimer. The patient had been on mechanical ventilation for 35 days, and was complicated by recurrent pneumothoraces, hypotension, and worsening hypoxia. An autopsy limited to the lungs was performed after the patient expired. Grossly, the lungs showed increased weight, adhesions on visceral pleural surface, patchy consolidation and dilated subpleural cysts. Histological examination revealed cystically dilated/remodeled airspaces with extensive coagulative necrosis, focal alveolar hemorrhage and edema, focal confluent fibrosis, and subpleural blebs. Fresh fibrinous thrombi were seen in small- and medium-sized vessels. Viral cytopathic changes or significant inflammation were not observed. The findings in the lungs were consistent with barotrauma in COVID-19. Results (if a Case Study enter NA) NA. Conclusion This case demonstrates various histopathologic changes of the lungs in a previously healthy and young COVID-19 patient with prolonged hospital course of mechanical ventilation. The features of diffuse alveolar damage with inflammation usually seen in the early stage of barotrauma are not identified. Our findings in the lungs may represent the histopathologic characteristics of the later stage of barotrauma in COVID-19.
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Background : One of the biggest challenges in the care of COVID-19 infected patients is predicting the severity of disease course and the need for ICU care and/or ventilator support. Published studies have suggested that D-dimer on admission can predict in-hospital mortality and prognosis. However, these data are mostly limited to adult populations with limited studies in pediatric populations. Aims : To determine if coagulation parameters at admission are associated with clinical severity of COVID-19 infection among pediatric patients. Methods : We retrospectively reviewed admission coagulation studies [Diagnostica Stago, Inc] (D-dimer, Prothrombin Time, PTTHepzyme, Fibrinogen and Platelet (PLT) count) in children with a COVID-19 diagnosis at a tertiary care pediatric hospital from April 2020 through February 2021. Disease severity was determined by ICU admission, length of stay (LOS), and need for ventilator support. Statistical analysis, including Mann Whitney U test and Pearson correlation was performed with data presented as mean ± SD with significance of P < 0.05. Results : There were 110 pediatric patients (57 females) ranging from 0.5 months to 18 years who had coagulation studies collected within 24 h of admission. Patients were divided into three groups based on ICU admission and ventilation support (see Table). Patients who required ICU admission and ventilation support had significantly higher D-dimer ( P = 0.0006) and PT ( P = 0.0083) values compared to patients who required neither. In addition, D-dimer was higher in this group when compared to those in the ICU only group ( P = 0.0099). Only D-dimer showed moderate correlation with LOS in the total cohort of patients ( r = 0.46, P < 0.0001) (Fig. 1). Conclusions : Elevated D-dimer significantly correlated with severity of disease and LOS, while elevated PT only correlated with disease severity. Our data suggest that D-dimer at admission may predict a pediatric patient's need for ICU care or ventilator support.