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Histopathology features of the lung in COVID-19 patients

M Angeles Montero-Fernandez1,2, Ricardo Pardo-Garcia1,2

  • 1Clinical Director of Cellular Pathology and Consultant Cardiothoracic Histopathologist, Manchester University NHS Foundation Trust, Senior Lecturer (Hon), Manchester University, Manchester, UK. Conflicts of interest: none declared.

Diagnostic Histopathology (Oxford, England)
|December 14, 2020
PubMed

Insights

The primary cause of death in COVID-19 patients is hypoxic respiratory failure, characterized by diffuse alveolar damage (DAD). Histopathological findings reveal distinct acute and organizing phases of DAD in lung tissues.

Area of Science:

  • Pulmonary Pathology
  • Infectious Diseases
  • Histopathology

Background:

  • COVID-19, caused by SARS-CoV-2, is a global pandemic.
  • Hypoxic respiratory failure from acute respiratory distress syndrome (ARDS) is the main cause of mortality.
  • Diffuse alveolar damage (DAD) is the characteristic histopathological finding in COVID-19 lung injury.

Purpose of the Study:

  • To describe the histopathological features of diffuse alveolar damage (DAD) in COVID-19.
  • To outline the distinct phases of DAD observed in lung specimens.
  • To discuss the specificity of DAD findings in the context of other viral infections.

Main Methods:

  • Histopathological examination of postmortem lung specimens from COVID-19 patients.
  • Analysis of morphological changes across different disease durations.
  • Comparison of DAD features with those observed in other viral pneumonias.

Main Results:

  • DAD presents with distinct morphological features in acute (exudative) and organizing (proliferative) phases.
  • The acute phase occurs within the first week, characterized by pulmonary injury.
  • The organizing phase follows, with additional features like vascular thrombosis, endothelialitis, and angiogenesis observed.

Conclusions:

  • DAD is a common histopathological finding in fatal COVID-19 cases.
  • The temporal evolution of DAD shows distinct phases with varying morphological characteristics.
  • The specificity of DAD in COVID-19 requires further investigation, as similar patterns are seen in other viral infections.

Keywords:
COVID-19CoV-2SARSdiffuse alveolar damagelung pathology

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