Lethal COVID-19: Radiologic-Pathologic Correlation of the Lungs

Area of Science:

• Radiology
• Pathology
• Pulmonology

Background:

• Coronavirus disease 2019 (COVID-19) is a severe respiratory illness.
• Understanding the pathological basis of COVID-19 is crucial for patient management.
• CT imaging is a primary tool for diagnosing and monitoring COVID-19 pneumonia.

Purpose of the Study:

• To correlate computed tomography (CT) findings with postmortem histopathology in fatal COVID-19 cases.
• To identify radiologic patterns associated with specific pathological changes in lethal COVID-19.
• To elucidate the role of vascular alterations in COVID-19 pathogenesis.

Main Methods:

• Retrospective analysis of 70 lung lobes from 14 patients deceased from COVID-19.
• Correlation of antemortem CT scans with postmortem autopsy findings.
• Lobewise comparison of radiologic and histopathologic observations graded by severity.

Main Results:

• Ground-glass opacities (GGO) and consolidation were predominant CT findings.
• Histopathology revealed diffuse alveolar damage, capillary congestion, and microthrombi in all cases.
• CT findings of GGO and consolidation corresponded to diffuse alveolar damage, vascular congestion, and microthrombosis.

Conclusions:

• CT findings, particularly GGO, significantly correlate with diffuse alveolar damage, capillary congestion, and microthrombosis.
• Vascular alterations are confirmed as critical pathophysiologic drivers in fatal COVID-19.
• This study highlights the importance of integrating CT imaging with pathology for understanding severe COVID-19.