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?:abstract
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CONTEXT Respiratory failure appears to be the ultimate mechanism of death in most patients with severe COVID-19 infection. Studies of postmortem COVID-19 lungs largely report diffuse alveolar damage (DAD) and capillary fibrin thrombi, but we have also observed other patterns. OBJECTIVE To report demographic and radiographic features along with macroscopic, microscopic, and microbiologic postmortem lung findings in patients with COVID-19 infections. DESIGN Patients with confirmed COVID-19 infection and postmortem examination (3/2020-5/2020) were included. Clinical findings were abstracted from medical records. Lungs were microscopically reviewed independently by 4 thoracic pathologists. Imaging studies were reviewed by a thoracic radiologist. RESULTS Eight patients (7 men, 87.5%; median age of 79 years, range, 69-96) died within a median of 17 days (range, 6-100) from onset of symptoms. The median lung weight was 1,220 g (range, 960-1,760); consolidations were found in 5 of 8 (62.5%) patients; gross thromboemboli were noted in one of 8 (12.5%) patient. Histologically, all patients had acute bronchopneumonia, 6 of 8 (75%) patients had also DAD. Two of 8 (25%) patients had aspiration pneumonia in addition. Thromboemboli, usually scattered and rare, were identified in 5 of 8 (62.5%) patients in small vessels and in two of these patients also in pulmonary arteries. Four of (50%) patients had perivascular chronic inflammation. Postmortem bacterial lung cultures were positive in 4 of 8 (50%) patients. Imaging studies (available in 4 patients) were typical (N=2, 50%), indeterminate (N=1, 25%), or negative (N=1, 25%) for COVID-19 infection. CONCLUSIONS Our study shows that patients infected with COVID-19 not only have DAD but also commonly have acute bronchopneumonia and aspiration pneumonia. These findings are important for management of these patients.
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