COVID‐19 related lung pathology: old patterns in new clothing?

Nicholson, Andrew G.; Osborn, Michael; Devaraj, Anand; Wells, Adrian

doi:10.1111/his.14162

Cited by 25 publications

(28 citation statements)

References 42 publications

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“…In addition, 1 patient in this study with radiologically suspected lung cancer was later proven to have histoplasmosis on surgical excision and no malignancy ( Figure 4 ). Of note, there was patchy interstitial chronic inflammation in the background lung, consistent with studies examining pathological changes in patients with COVID-19 infection which have also reported patchy inflammatory cellular infiltrates without hyaline membrane formation in early phase infection [ 36 , 37 , 38 , 39 ]. Severe COVID-19 lung pathology, such as diffuse alveolar damage and thrombotic changes which can progress to fibrosis weeks to months later, were not detected in this asymptomatic patient [39] .…”

Section: Discussionsupporting

confidence: 83%

Real-world outcomes in thoracic cancer patients with severe Acute respiratory syndrome Coronavirus 2 (COVID-19): Single UK institution experience

Cui

Yousaf

Bhosle

et al. 2020

Cancer Treatment and Research Communications

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Section: Discussionsupporting

confidence: 83%

Real-world outcomes in thoracic cancer patients with severe Acute respiratory syndrome Coronavirus 2 (COVID-19): Single UK institution experience

Cui

Yousaf

Bhosle

et al. 2020

Cancer Treatment and Research Communications

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“… Analysis of the clinical, laboratory, and radiological factors related to respiratory failure (RF) First, we divided subjects into two groups based on the maximum oxygen demand for evaluation as a primary outcome according to the WHO guidance [ 10 ]: RF group, ≥ 5 L; non-RF group, < 5 L. The presence or absence of RF was judged for the period that was presumed to be the peak period across the entire course of each case. We analyzed which factors (clinical findings, laboratory data, and CT patterns) correlated with RF using multivariate analysis.…”

Section: Methodsmentioning

confidence: 99%

An analysis of the radiological factors associated with respiratory failure in COVID-19 pneumonia and the CT features among different age categories

et al. 2021

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Purpose To investigate CT patterns of COVID-19 pneumonia associated with respiratory failure (RF) focused on the distribution of lesions. Materials and methods Eighty-five patients with COVID-19 pneumonia were reviewed. CT findings were classified as follows: Type A; patchy ground glass attenuation (GGA) with/without air-space consolidation, Type B; non-segmental GGA with/without air-space consolidation in both the central and peripheral lung portions especially with subpleural spare, and Type C; non-segmental GGA with/without air-space consolidation predominantly distributed in the peripheral lung portion without subpleural spare. We analyzed CT patterns and clinical factors associated with RF, including age categories. Results The number of patients with Type A, B and C was 31 (37%), 24 (28%) and 30 (35%), respectively. Type C and hypertension were independently associated with RF. On comparing between Types B and C, the frequency of traction bronchiectasis was higher in Type C than in Type B ( P < 0.001). The ratio of Type C in patients ≥ 65 years old (66%) was higher than in patients < 40 years old ( P < 0.001) and 40–49 years old ( P = 0.001). Conclusion The Type C, increasing with age, was associated with RF. Traction bronchiectasis in the lesion was more frequent in Type C than in Type B. Secondary abstract A lesion adjacent to the pleura and hypertension is associated with respiratory failure in patients with COVID-19. The frequency of a lesion adjacent to the pleura increased with age. The distribution of lesions is a useful parameter to predict respiratory failure.

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“…While patient #1 represents an early phase of the host response to SARS-CoV-2 infection, both TBBs and autopsy samples from patient #2 showed widespread DAD with ball-like-fibrin and fibromyxoid plugging. This acute fibrinous and organizing pneumonia (AFOP)-like pattern has previously been reported in response to SARS-CoV-2 infection, and is believed to represent an intermediate form of lung injury between exudative DAD and OP 6 25 . In line with that, we think that the pattern of lung injury we observed in this patient represents the climax of lung injury in response to SARS-CoV-2 infection, and the virus could be detected in all samples from this patient by RT-PCR and FISH, respectively.…”

Section: Discussionmentioning

confidence: 58%

“…Based on a meta-analysis of 131 reported autopsy cases, Polak et al postulated that the main histologic patterns of COVID-19-related lung injury can be categorized into epithelial (reactive changes and DAD), vascular (microvascular damage, thrombi and OP) and fibrotic 5 , however these patterns may overlap and be coexistent in the same patient at a given time point. Nicholson et al proposed that an initial (pre-)exudative phase of DAD (0-7 days) is followed by an organizing phase (1 week to months) and might ultimately progress to fibrosis (months) 6 . The exact mechanisms of SARS-CoV-2-related ARDS development are not fully understood.…”

mentioning

confidence: 99%

Antemortem vs. postmortem histopathological and ultrastructural findings in paired transbronchial biopsies and lung autopsy samples from three patients with confirmed SARS-CoV-2 infection

Gagiannis

Umathum

Bloch

et al. 2021

Preprint

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BackgroundAcute respiratory distress syndrome (ARDS) is the major cause of death in coronavirus disease 2019 (COVID-19). Multiple autopsy-based reports of COVID-19 lung pathology describe diffuse alveolar damage (DAD), organizing pneumonia (OP) and fibrotic change, but data on early pathological changes as well as during progression of the disease are rare.Research questionComparison of histopathological and ultrastructural findings in paired transbronchial biopsies (TBBs) and autopsy material from three patients with confirmed SARS-CoV-2-infection.MethodsWe prospectively enrolled 3 patients with confirmed SARS-CoV-2 infection. Full clinical evaluation was performed including high-resolution computed tomography (HR-CT). We took TBBs at different time points during the disease and autopsy tissue samples after the patients’ death.ResultsSARS-CoV-2 was detected by RT-PCR and/or FISH in all TBBs. Lung histology revealed pneumocyte hyperplasia and capillary congestion in one patient who died short after hospital admission with detectable virus in 1/2 autopsy samples from the lung. SARS-CoV-2 was detected in 2/2 autopsy samples from a patient with a fulminant course of the disease and very short latency between biopsy and autopsy, both showing widespread DAD. In a third patient with a prolonged course, i.e. five weeks of ICU treatment with ECMO, autopsy samples showed extensive interstitial fibrosis without detectable virus by RT-PCR and/or FISH.InterpretationWe report the course of COVID-19 in paired TBB and autopsy samples from three patients at an early stage, in rapidly progressive and in a prolonged disease course. Our findings illustrate vascular, organizing and fibrotic patterns of COVID-19-induced lung injury and suggest an early spread of SARS-CoV-2 from the upper airways to the lung periphery with diminishing viral load during disease.

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COVID‐19 related lung pathology: old patterns in new clothing?

Cited by 25 publications

References 42 publications

Real-world outcomes in thoracic cancer patients with severe Acute respiratory syndrome Coronavirus 2 (COVID-19): Single UK institution experience

Real-world outcomes in thoracic cancer patients with severe Acute respiratory syndrome Coronavirus 2 (COVID-19): Single UK institution experience

An analysis of the radiological factors associated with respiratory failure in COVID-19 pneumonia and the CT features among different age categories

Antemortem vs. postmortem histopathological and ultrastructural findings in paired transbronchial biopsies and lung autopsy samples from three patients with confirmed SARS-CoV-2 infection

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