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Analysis of cardiopulmonary findings in COVID-19 fatalities: High incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia.
Grosse, Claudia; Grosse, Alexandra; Salzer, Helmut J F; Dünser, Martin W; Motz, Reinhard; Langer, Rupert.
  • Grosse C; Institute of Pathology and Microbiology, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria. Electronic address: claudiagrosse@gmx.at.
  • Grosse A; Institute of Pathology and Microbiology, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.
  • Salzer HJF; Department of Pulmonology, Kepler University Hospital, Krankenhausstrasse 9, 4041 Linz, Austria.
  • Dünser MW; Department of Anaesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.
  • Motz R; Institute of Pathology and Microbiology, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.
  • Langer R; Institute of Pathology and Microbiology, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.
Cardiovasc Pathol ; 49: 107263, 2020.
Article in English | MEDLINE | ID: covidwho-650406
ABSTRACT
Since its recognition in December 2019, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has rapidly spread globally causing a pandemic that represents the greatest medical challenge in decades. The aim of the study was to evaluate the spectrum of cardiopulmonary pathology of COVID-19 based on (non-minimal invasive) autopsies performed on 14 COVID-19 decedents. Bilateral diffuse alveolar damage (DAD) was found in all patients. Superimposed acute bronchopneumonia was present in 11 of 14 (78.6%) patients and was considered the major cause of death in 2 patients. A key finding was the presence of thrombotic/thromboembolic vascular occlusions. We classified 5 types of pulmonary thrombi 1. capillary microthrombi (11/14, 78.6%); 2. partially organized thrombi in mid-sized pulmonary arteries with complete vessel occlusion; 3. non-organized thrombi in mid-sized pulmonary arteries that did not completely fill out the vessel lumen and probably represented thromboemboli rather than thrombosis; 4. bone marrow emboli (1/14, 7.1%); and 5. septic pulmonary thromboemboli (1/14, 7.1%). Pulmonary thrombi in mid-sized arteries were noted in 5 of 14 (35.7%) patients, causing pulmonary infarction and/or pulmonary hemorrhage. All patients had evidence of chronic cardiac disease, including myocardial hypertrophy (13/14, 92.9%), mild to marked coronary artery atherosclerosis (14/14, 100%) and focal myocardial fibrosis (3/14, 21.4%). Acute myocardial infarction was found as concurrent cause of death in 3 (21.4%) patients, and significant cardiac hypertrophy (heart weight 750 g) was present in 1 (7.1%) patient with ATTR-positive cardiac amyloidosis. The autopsy findings confirm that COVID-19 is a systemic disease, with major involvement of the lungs, that increases the risk of cardiac and vascular complications including acute myocardial injury and thrombotic/thromboembolic events. Secondary acute bronchopneumonia is a common complication in patients with COVID-19 and may be the major cause of death.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Pulmonary Artery / Thrombosis / Bronchopneumonia / Coronavirus Infections Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Cardiovasc Pathol Journal subject: Vascular Diseases / Cardiology / Pathology Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Pulmonary Artery / Thrombosis / Bronchopneumonia / Coronavirus Infections Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Cardiovasc Pathol Journal subject: Vascular Diseases / Cardiology / Pathology Year: 2020 Document Type: Article