Gross Pathology in COVID-19

Abstract

The global infectious disease COVID-19 is caused by SARS-CoV-2, a new member of the Coronaviridae family. Though presented as a novel disease that primarily affects the respiratory system, multi-organ involvement has been well-noticed and documented since the beginning of the pandemic. When performed properly with adequate safety measures, autopsy provides the most valuable information to decipher the pathogenesis of this novel disease, therefore providing a basis for clinical management. In addition to reviewing the macroscopic changes in organs and tissues involved in COVID-19, the relevant microscopic alterations and possible pathogenesis are also discussed.

A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications

“…The CT features in breakthrough infections and the CT features of COVID-19 pneumonia in the different waves of pandemic are summarized in Table 3. An uncontrolled immune response to SARS-CoV-2 infection can lead to acute respiratory distress syndrome (ARDS), which was a relatively common complication of COVID-19 pneumonia in the first waves [99][100][101][102][103][104]. COVID-19 patients with ARDS were usually older and had comorbidities [100].…”

“…In the acute phase, a tendency towards dense consolidation involving the dependent posterior lower lobes while mostly sparing the anterior or non-dependent area has been observed [37,103] (Figure 15). ARDS in COVID-19 patients has been frequent since the Delta variant [37,99,[104][105][106]. However, the risk of ARDS was lower during the Omicron variant [107].…”

“…Some rare cases of ARDS were reported after COVID-19 vaccinations as possible consequences of antibody-dependent enhancement (ADE) [108,109] (Figure 16). ARDS in COVID-19 patients has been frequent since the Delta variant [37,99,[104][105][106]. However, the risk of ARDS was lower during the Omicron variant [107].…”

“…An uncontrolled immune response to SARS-CoV-2 infection can lead to acute respiratory distress syndrome (ARDS), which was a relatively common complication of COVID-19 pneumonia in the first waves [ 99 , 100 , 101 , 102 , 103 , 104 ]. COVID-19 patients with ARDS were usually older and had comorbidities [ 100 ].…”

“…COVID-19 ARDS is caused by both direct viral action and the indirect effect of the hyperactivation of the host immune system, which can cause the excessive production of proinflammatory cytokines, i.e., cytokine storms. COVID-19 ARDS differs from typical ARDS due to the existence of endothelial injury characterized by the presence of pulmonary capillary microthrombi, in addition to typical diffused alveolar injury [ 99 , 100 , 101 , 102 , 103 , 104 , 105 ]. This was revealed by histopathological examinations, although autopsies were rare in the first wave of the pandemic [ 103 ].…”