Forty Postmortem Examinations in COVID-19 Patients

Area of Science:

• Pulmonary pathology
• COVID-19 research
• Autopsy studies

Background:

• Diffuse alveolar damage (ALI) is the most common pattern in COVID-19 lung pathology.
• Other less common or novel pathologic patterns have been observed in COVID-19 decedents.

Purpose of the Study:

• To review autopsies from COVID-19 decedents.
• To evaluate the spectrum of pulmonary pathology.
• To correlate pathologic findings with clinical, laboratory, and radiologic data.

Main Methods:

• Comprehensive and quantitative review of 40 postmortem examinations.
• Categorization of microscopic patterns as 'major' (>=50% of cases) or 'novel' (rarely described).

Main Results:

• Three major patterns identified: ALI (73%), intravascular fibrin/platelet-rich aggregates (IFPAs) (90%), and vascular congestion/hemangiomatosis-like change (VCHL) (50%).
• A novel non-ALI pattern was observed in 27% of cases.
• Non-ALI decedents had shorter hospitalizations, less consolidation on radiographs, and often cardiac arrest as clinical presentation, with IFPAs and VCHL present.

Conclusions:

• Two distinct pulmonary phenotypic patterns, ALI and non-ALI, were identified in COVID-19 decedents.
• The non-ALI phenotype is rarely described and characterized by IFPAs and VCHL.
• The cause of death in non-ALI cases is likely COVID-19 related but requires further corroboration.