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BACKGROUND: CT has emerged as an important diagnostic tool in COVID-19, but the underlying pathological changes behind CT findings are not yet fully elucidated. PURPOSE: The purpose of this retrospective study was to correlate CT patterns of fatal cases of COVID-19 with post-mortem pathology observations. MATERIAL AND METHODS: The study included 70 lung lobes of 14 patients who died from RT-PCR confirmed COVID-19. All patients underwent ante-mortem CT and autopsy between March 9 and April 30, 2020. Board-certified radiologists and pathologists performed lobe-wise correlations of pulmonary observations. In a consensus reading, 267 radiological and 257 histopathological observations of the lungs were recorded and systematically graded according to severity. These observations were matched and evaluated. RESULTS: Predominant CT observations were ground glass opacities (GGO; 59 of 70 lobes examined) and areas of consolidation (33/70). The histopathological observations were consistent with diffuse alveolar damage (70/70), capillary dilatation and congestion (70/70), often accompanied by microthrombi (27/70), superimposed acute bronchopneumonia (17/70) and leukocytoclastic vasculitis (7/70). Four patients had pulmonary emboli. Bronchial wall thickening on CT histologically corresponded with acute bronchopneumonia. GGOs and consolidations corresponded with mixed histopathological observations including capillary dilation and congestion, interstitial edema, diffuse alveolar damage and microthrombosis. Vascular alterations were prominent observations in both CT and histopathology. CONCLUSION: A significant proportion of GGO correlated with the pathologic processes of diffuse alveolar damage, capillary dilatation and congestion and microthrombosis. Our results confirm the presence and underline the importance of vascular alterations as a key pathophysiological driver in lethal COVID-19.
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Radiol_Cardiothorac_Imaging
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document_parses/pdf_json/3f441fa4483dd9e288ce3bddc985aaeec55736d0.json
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document_parses/pmc_json/PMC7681778.xml.json
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Lethal COVID-19: Radiological-Pathological Correlation of the Lungs
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