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Analysis of cardiopulmonary findings in COVID-19 fatalities: High incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia.
Cardiovasc Pathol. 2020 Nov - Dec; 49:107263.CP

Abstract

Since its recognition in December 2019, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has rapidly spread globally causing a pandemic that represents the greatest medical challenge in decades. The aim of the study was to evaluate the spectrum of cardiopulmonary pathology of COVID-19 based on (non-minimal invasive) autopsies performed on 14 COVID-19 decedents. Bilateral diffuse alveolar damage (DAD) was found in all patients. Superimposed acute bronchopneumonia was present in 11 of 14 (78.6%) patients and was considered the major cause of death in 2 patients. A key finding was the presence of thrombotic/thromboembolic vascular occlusions. We classified 5 types of pulmonary thrombi: 1. capillary microthrombi (11/14, 78.6%); 2. partially organized thrombi in mid-sized pulmonary arteries with complete vessel occlusion; 3. non-organized thrombi in mid-sized pulmonary arteries that did not completely fill out the vessel lumen and probably represented thromboemboli rather than thrombosis; 4. bone marrow emboli (1/14, 7.1%); and 5. septic pulmonary thromboemboli (1/14, 7.1%). Pulmonary thrombi in mid-sized arteries were noted in 5 of 14 (35.7%) patients, causing pulmonary infarction and/or pulmonary hemorrhage. All patients had evidence of chronic cardiac disease, including myocardial hypertrophy (13/14, 92.9%), mild to marked coronary artery atherosclerosis (14/14, 100%) and focal myocardial fibrosis (3/14, 21.4%). Acute myocardial infarction was found as concurrent cause of death in 3 (21.4%) patients, and significant cardiac hypertrophy (heart weight 750 g) was present in 1 (7.1%) patient with ATTR-positive cardiac amyloidosis. The autopsy findings confirm that COVID-19 is a systemic disease, with major involvement of the lungs, that increases the risk of cardiac and vascular complications including acute myocardial injury and thrombotic/thromboembolic events. Secondary acute bronchopneumonia is a common complication in patients with COVID-19 and may be the major cause of death.

Authors+Show Affiliations

Institute of Pathology and Microbiology, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria. Electronic address: claudiagrosse@gmx.at.Institute of Pathology and Microbiology, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.Department of Pulmonology, Kepler University Hospital, Krankenhausstrasse 9, 4041 Linz, Austria.Department of Anaesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.Institute of Pathology and Microbiology, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.Institute of Pathology and Microbiology, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32784110

Citation

Grosse, Claudia, et al. "Analysis of Cardiopulmonary Findings in COVID-19 Fatalities: High Incidence of Pulmonary Artery Thrombi and Acute Suppurative Bronchopneumonia." Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology, vol. 49, 2020, p. 107263.
Grosse C, Grosse A, Salzer HJF, et al. Analysis of cardiopulmonary findings in COVID-19 fatalities: High incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia. Cardiovasc Pathol. 2020;49:107263.
Grosse, C., Grosse, A., Salzer, H. J. F., Dünser, M. W., Motz, R., & Langer, R. (2020). Analysis of cardiopulmonary findings in COVID-19 fatalities: High incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia. Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology, 49, 107263. https://doi.org/10.1016/j.carpath.2020.107263
Grosse C, et al. Analysis of Cardiopulmonary Findings in COVID-19 Fatalities: High Incidence of Pulmonary Artery Thrombi and Acute Suppurative Bronchopneumonia. Cardiovasc Pathol. 2020 Nov - Dec;49:107263. PubMed PMID: 32784110.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analysis of cardiopulmonary findings in COVID-19 fatalities: High incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia. AU - Grosse,Claudia, AU - Grosse,Alexandra, AU - Salzer,Helmut J F, AU - Dünser,Martin W, AU - Motz,Reinhard, AU - Langer,Rupert, Y1 - 2020/07/16/ PY - 2020/06/11/received PY - 2020/07/09/revised PY - 2020/07/12/accepted PY - 2020/8/14/pubmed PY - 2020/9/26/medline PY - 2020/8/14/entrez KW - Autopsy KW - COVID-19 KW - Cardiopulmonary pathology KW - Coronavirus KW - Diffuse alveolar damage KW - SARS-CoV-2 SP - 107263 EP - 107263 JF - Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology JO - Cardiovasc Pathol VL - 49 N2 - Since its recognition in December 2019, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has rapidly spread globally causing a pandemic that represents the greatest medical challenge in decades. The aim of the study was to evaluate the spectrum of cardiopulmonary pathology of COVID-19 based on (non-minimal invasive) autopsies performed on 14 COVID-19 decedents. Bilateral diffuse alveolar damage (DAD) was found in all patients. Superimposed acute bronchopneumonia was present in 11 of 14 (78.6%) patients and was considered the major cause of death in 2 patients. A key finding was the presence of thrombotic/thromboembolic vascular occlusions. We classified 5 types of pulmonary thrombi: 1. capillary microthrombi (11/14, 78.6%); 2. partially organized thrombi in mid-sized pulmonary arteries with complete vessel occlusion; 3. non-organized thrombi in mid-sized pulmonary arteries that did not completely fill out the vessel lumen and probably represented thromboemboli rather than thrombosis; 4. bone marrow emboli (1/14, 7.1%); and 5. septic pulmonary thromboemboli (1/14, 7.1%). Pulmonary thrombi in mid-sized arteries were noted in 5 of 14 (35.7%) patients, causing pulmonary infarction and/or pulmonary hemorrhage. All patients had evidence of chronic cardiac disease, including myocardial hypertrophy (13/14, 92.9%), mild to marked coronary artery atherosclerosis (14/14, 100%) and focal myocardial fibrosis (3/14, 21.4%). Acute myocardial infarction was found as concurrent cause of death in 3 (21.4%) patients, and significant cardiac hypertrophy (heart weight 750 g) was present in 1 (7.1%) patient with ATTR-positive cardiac amyloidosis. The autopsy findings confirm that COVID-19 is a systemic disease, with major involvement of the lungs, that increases the risk of cardiac and vascular complications including acute myocardial injury and thrombotic/thromboembolic events. Secondary acute bronchopneumonia is a common complication in patients with COVID-19 and may be the major cause of death. SN - 1879-1336 UR - https://www.unboundmedicine.com/medline/citation/32784110/Analysis_of_cardiopulmonary_findings_in_COVID_19_fatalities:_High_incidence_of_pulmonary_artery_thrombi_and_acute_suppurative_bronchopneumonia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1054-8807(20)30067-3 DB - PRIME DP - Unbound Medicine ER -