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The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities.
Cardiovasc Pathol. 2020 Sep - Oct; 48:107233.CP

Abstract

This paper collates the pathological findings from initial published autopsy reports on 23 patients with coronavirus disease 2019 (COVID-19) from 5 centers in the United States of America, including 3 cases from Houston, Texas. Findings confirm that COVID-19 is a systemic disease with major involvement of the lungs and heart. Acute COVID-19 pneumonia has features of a distinctive acute interstitial pneumonia with a diffuse alveolar damage component, coupled with microvascular involvement with intra- and extravascular fibrin deposition and intravascular trapping of neutrophils, and, frequently, with formation of microthombi in arterioles. Major pulmonary thromboemboli with pulmonary infarcts and/or hemorrhage occurred in 5 of the 23 patients. Two of the Houston cases had interstitial pneumonia with diffuse alveolar damage pattern. One of the Houston cases had multiple bilateral segmental pulmonary thromboemboli with infarcts and hemorrhages coupled with, in nonhemorrhagic areas, a distinctive interstitial lymphocytic pneumonitis with intra-alveolar fibrin deposits and no hyaline membranes, possibly representing a transition form to acute fibrinous and organizing pneumonia. Multifocal acute injury of cardiac myocytes was frequently observed. Lymphocytic myocarditis was reported in 1 case. In addition to major pulmonary pathology, the 3 Houston cases had evidence of lymphocytic pericarditis, multifocal acute injury of cardiomyocytes without inflammatory cellular infiltrates, depletion of splenic white pulp, focal hepatocellular degeneration and rare glomerular capillary thrombosis. Each had evidence of chronic cardiac disease: hypertensive left ventricular hypertrophy (420 g heart), dilated cardiomyopathy (1070 g heart), and hypertrophic cardiomyopathy (670 g heart). All 3 subjects were obese (BMIs of 33.8, 51.65, and 35.2 Kg/m2). Overall, the autopsy findings support the concept that the pathogenesis of severe COVID-19 disease involves direct viral-induced injury of multiple organs, including heart and lungs, coupled with the consequences of a procoagulant state with coagulopathy.

Authors+Show Affiliations

Departments of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA. Electronic address: l.maximilian.buja@uth.tmc.edu.Harris County Institute of Forensic Sciences, Houston, Texas, USA.Departments of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA; Center for Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas, USA.Departments of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.Departments of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.Departments of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA."Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and Sudden Infant Death Syndrome, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.Department of Pathology, Baylor College of Medicine and Texas Childrens Hospital, Houston, Texas, USA.Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA; Lyndon B. Johnson General Hospital, Harris Health, Houston, Texas, USA.Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA; Center for Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32434133

Citation

Buja, Louis Maximilian, et al. "The Emerging Spectrum of Cardiopulmonary Pathology of the Coronavirus Disease 2019 (COVID-19): Report of 3 Autopsies From Houston, Texas, and Review of Autopsy Findings From Other United States Cities." Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology, vol. 48, 2020, p. 107233.
Buja LM, Wolf DA, Zhao B, et al. The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities. Cardiovasc Pathol. 2020;48:107233.
Buja, L. M., Wolf, D. A., Zhao, B., Akkanti, B., McDonald, M., Lelenwa, L., Reilly, N., Ottaviani, G., Elghetany, M. T., Trujillo, D. O., Aisenberg, G. M., Madjid, M., & Kar, B. (2020). The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities. Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology, 48, 107233. https://doi.org/10.1016/j.carpath.2020.107233
Buja LM, et al. The Emerging Spectrum of Cardiopulmonary Pathology of the Coronavirus Disease 2019 (COVID-19): Report of 3 Autopsies From Houston, Texas, and Review of Autopsy Findings From Other United States Cities. Cardiovasc Pathol. 2020 Sep - Oct;48:107233. PubMed PMID: 32434133.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities. AU - Buja,Louis Maximilian, AU - Wolf,Dwayne A, AU - Zhao,Bihong, AU - Akkanti,Bindu, AU - McDonald,Michelle, AU - Lelenwa,Laura, AU - Reilly,Noah, AU - Ottaviani,Giulia, AU - Elghetany,M Tarek, AU - Trujillo,Daniel Ocazionez, AU - Aisenberg,Gabriel M, AU - Madjid,Mohammad, AU - Kar,Biswajit, Y1 - 2020/05/07/ PY - 2020/04/21/received PY - 2020/04/27/revised PY - 2020/04/28/accepted PY - 2020/5/21/pubmed PY - 2020/7/2/medline PY - 2020/5/21/entrez KW - Autopsy KW - COVID-19 KW - Coagulopathy KW - Diffuse alveolar damage KW - Heart KW - Kidney KW - Liver KW - SARS-CoV-2 KW - Spleen KW - Viral pneumonia SP - 107233 EP - 107233 JF - Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology JO - Cardiovasc. Pathol. VL - 48 N2 - This paper collates the pathological findings from initial published autopsy reports on 23 patients with coronavirus disease 2019 (COVID-19) from 5 centers in the United States of America, including 3 cases from Houston, Texas. Findings confirm that COVID-19 is a systemic disease with major involvement of the lungs and heart. Acute COVID-19 pneumonia has features of a distinctive acute interstitial pneumonia with a diffuse alveolar damage component, coupled with microvascular involvement with intra- and extravascular fibrin deposition and intravascular trapping of neutrophils, and, frequently, with formation of microthombi in arterioles. Major pulmonary thromboemboli with pulmonary infarcts and/or hemorrhage occurred in 5 of the 23 patients. Two of the Houston cases had interstitial pneumonia with diffuse alveolar damage pattern. One of the Houston cases had multiple bilateral segmental pulmonary thromboemboli with infarcts and hemorrhages coupled with, in nonhemorrhagic areas, a distinctive interstitial lymphocytic pneumonitis with intra-alveolar fibrin deposits and no hyaline membranes, possibly representing a transition form to acute fibrinous and organizing pneumonia. Multifocal acute injury of cardiac myocytes was frequently observed. Lymphocytic myocarditis was reported in 1 case. In addition to major pulmonary pathology, the 3 Houston cases had evidence of lymphocytic pericarditis, multifocal acute injury of cardiomyocytes without inflammatory cellular infiltrates, depletion of splenic white pulp, focal hepatocellular degeneration and rare glomerular capillary thrombosis. Each had evidence of chronic cardiac disease: hypertensive left ventricular hypertrophy (420 g heart), dilated cardiomyopathy (1070 g heart), and hypertrophic cardiomyopathy (670 g heart). All 3 subjects were obese (BMIs of 33.8, 51.65, and 35.2 Kg/m2). Overall, the autopsy findings support the concept that the pathogenesis of severe COVID-19 disease involves direct viral-induced injury of multiple organs, including heart and lungs, coupled with the consequences of a procoagulant state with coagulopathy. SN - 1879-1336 UR - https://www.unboundmedicine.com/medline/citation/32434133/The_emerging_spectrum_of_cardiopulmonary_pathology_of_the_coronavirus_disease_2019__COVID_19_:_Report_of_3_autopsies_from_Houston_Texas_and_review_of_autopsy_findings_from_other_United_States_cities_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1054-8807(20)30037-5 DB - PRIME DP - Unbound Medicine ER -