Lung fibrosis: an undervalued finding in COVID-19 pathological series

Grillo, Federica; Barisione, Emanuela; Ball, Lorenzo; Mastracci, Luca; Fiocca, Roberto

doi:10.1016/s1473-3099(20)30582-x

Cited by 110 publications

(97 citation statements)

References 5 publications

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“…For example, these findings were observed in one case at one time point postmortem [14]. Also, in a recent publication in Lancet Infectious disease [22], a total of eight COVID-19 patients who died from the disease were undergone postmortem histopathologic evaluation of tissue samples obtained by cryobiopsy within 30 min of death. The authors reported significant fibrotic pulmonary parenchymal remodeling, as characterized by fibroblast proliferation, micro-honeycombing, and airspace obliteration.…”

Section: Possibility Of Long-term Pulmonary Abnormalitiesmentioning

confidence: 94%

The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

Shaw

Daskareh²,

Gholamrezanezhad

2020

Radiol med

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The long-term sequelae of coronavirus disease 2019 (COVID-19) are still unknown. Lessons from past viral epidemics reveal that, after recovery, patients with viral pulmonary infections can suffer from irreversible pulmonary dysfunction and demonstrate residual imaging or functional abnormalities. Residual ground glass opacities, consolidations, reticular and linear opacities, residual crazy paving pattern, melted sugar sign, and parenchymal fibrotic bands are several features found in the late or remission stages of COVID-19. These radiologic findings have been observed weeks after symptom onset, even after hospital discharge, and they may or may not correlate with clinical manifestations. High-resolution CT may be indicated to establish new baselines and track changes in residual impairments. In our previous review, we observed significant pulmonary sequelae in some COVID-19 survivors at follow-up. In this update, we review the current literature on the clinical and radiologic manifestations of post-recovery COVID-19 toward the end of hospital admission and after discharge.

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Section: Possibility Of Long-term Pulmonary Abnormalitiesmentioning

confidence: 94%

The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

Shaw

Daskareh²,

Gholamrezanezhad

2020

Radiol med

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“…In another work also from Tian S et al [48], organization with fibroblasts in the intralveolar space was reported. Additionally, Bradley B T et al [49], reported fibroblastic proliferation in 92% of pulmonary autopsies from COVID-19 patients and Grillo F et al [50], fibrous parenchymal remodeling with fibroblast proliferation. Therefore, it can be inferred that there is a miscellaneous in cases of DAD secondary to COVID-19, since both exudative and proliferative phases are present in the cases, and sometimes even in the same patient, denoting a heterogeneity of lung damage caused by the virus.…”

Section: Pathologymentioning

confidence: 99%

“…Franks T J et al (43) Tian S et al (44) Lacy J et al (45( Konopka K et al (46) Zhang H et al 47) Tian S et al 48) Bradley B T et al 49) Grillo F et al 50) Alveolar hemorrhage…”

Section: Characteristicsmentioning

confidence: 99%

Pulmonary pathology of ARDS in COVID-19: A pathological review for clinicians

Batah

Fabro

2021

Respiratory Medicine

246

206

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COVID-19 has quickly reached pandemic levels since it was first reported in December 2019. The virus responsible for the disease, named SARS-CoV-2, is enveloped positive-stranded RNA viruses. During its replication in the cytoplasm of host cells, the viral genome is transcribed into proteins, such as the structural protein spike domain S1, which is responsible for binding to the cell receptor of the host cells. Infected patients have initially flu-like symptoms, rapidly evolving to severe acute lung injury, known as acute respiratory distress syndrome (ARDS). ARDS is characterized by an acute and diffuse inflammatory damage into the alveolarcapillary barrier associated with a vascular permeability increase and reduced compliance, compromising gas exchange and causing hypoxemia. Histopathologically, this condition is known as diffuse alveolar damage which consists of permanent damage to the alveoli epithelial cells and capillary endothelial cells, with consequent hyaline membrane formation and eventually intracapillary thrombosis. All of these mechanisms associated with COVID-19 involve the phenotypic expression from different proteins transcription modulated by viral infection in specific pulmonary microenvironments. Therefore, this knowledge is fundamentally important for a better pathophysiological understanding and identification of the main molecular pathways associated with the disease evolution. Evidently, clinical findings, signs and symptoms of a patient are the phenotypic expression of these pathophysiological and molecular mechanisms of SARS-CoV-2 infection. Therefore, no findings alone, whether molecular, clinical, radiological or pathological axis are sufficient for an accurate diagnosis. However, their intersection and/or correlation are extremely critical for clinicians establish the diagnosis and new treatment perspectives.

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“…In the initial studies, Pan et al and Zhou et al reported brotic changes in the imaging features of patients with COVID-19 pneumonia [12,15]. Since then, brotic lung parenchymal remodelling [16,17], brosing diffuse alveolar damage (DAD) [18] and honey combing [19] have also been con rmed after invasive testing such as cryobiopsies and autopsies in smaller cohorts. Li Yan et al described DAD on autopsy of 30 patients with COVID-19, showing 43% developing brosing patterns while 25% showing organizing pattern [6].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Interstitial Lung Disease - An Emerging Entity

Zubairi¹,

Shaikh

Zubair

et al. 2020

Preprint

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Background: COVID-19 disease associated pulmonary sequalae has been increasingly reported after recovery from acute infection. Therefore, we aim to explore the charactersitics of interstitial lung disease in patients with COVID-19.Methods: An observational study was conducted in patients with COVID-19 associated ILD from April 2020 till September 2020. Patients ≥18 years of age with COVID-19 who were diagnosed with ILD based on respiratory symptoms and HRCT chest imaging after the recovery phase of COVID-19 infection were recruited. Data was recorded on a structured proforma, and descriptive analysis was performed using Stata version 12.1.Results: A total of 30 patients with COVID-associated ILD were identified. The mean age of patients was 59.14 (SD 12.60) and 27 (90%) were males. Four HRCT patterns of interstitial lung disease were seen; organizing pneumonia in 10 (33.33%), non-specific interstitial pneumonitis in 17 (56.67%), usual interstitial pneumonitis in 12 (40%) and probable usual interstitial pneumonitis in 14 (46.67%). Diffuse involvement was found in 15 (50%) patients, while peripheral predominance in 15 (50%) and other significant findings were seen in 8 (26.67%) patients. All patients were treated with corticosteroids. The case fatality rate was 16.67%. Amongst the survivors, 8 (32%) recovered completely, 9 (36%) improved, while 8 (32%) patients had static or progressive disease.Conclusions: This is the first study from Southeast Asia that identified COVID-associated interstitial lung disease in patients who had no pre-existing lung disease, highlighting the importance of timely recognition and treatment of an entity that might lead to fatal outcome.

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Lung fibrosis: an undervalued finding in COVID-19 pathological series

Cited by 110 publications

References 5 publications

The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

Pulmonary pathology of ARDS in COVID-19: A pathological review for clinicians

COVID-19 Associated Interstitial Lung Disease - An Emerging Entity

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