Postmortem CT pulmonary findings in SARS-CoV-2-positive cases: correlation with lung histopathological findings and autopsy results

Abstract

Introduction/purpose Postmortem computed tomography (PMCT) is a valuable tool for analyzing the death of patients with SARS-CoV-2 infection. The purpose of this study was to investigate the correlation between PMCT lung findings in autopsy cadavers positive for SARS-CoV-2 infection and the severity of COVID-19 lung disease by histopathological analysis. Materials and methodsWe reviewed chest PMCT findings, paying particular attention to the lung parenchyma, in 8 autopsy cases positive for SARS-CoV-2. Correlations between chest PMCT and histopathological findings were assessed. Clinical conditions and comorbidities were also recorded and discussed. The primary cause of death was finally considered. Results In 6/8 cases, pulmonary PMCT findings were massive consolidation (4/8) and bilateral diffuse mixed densities with a crazy-paving pattern (2/8). These cases showed severe pulmonary signs of COVID-19 at histopathological analysis. In the remaining 2/8 cases, pulmonary PMCT findings were scant antideclive ground-glass opacities in prevalent gradient densities attributed to hypostasis. In 4/8 cases with massive consolidations, important comorbidities were noted. In 6/8 cases with severe pulmonary histopathological signs of lung COVID-19, autopsy found that the cause of death was cardiorespiratory failure. In the remaining 2/8 cases, histopathological analysis revealed lung alterations due to edema and some signs of SARS-CoV-2 infection; the cause of death was not attributed to SARS-CoV-2 infection (Table 1). Discussion and conclusion Chest PMCT findings correlate with the severity of COVID-19 lung disease at histopathology examination. According to our results, there may also be a relationship between cause of death and PMCT findings in COVID-19, which must be critically analyzed considering clinical antemortem data.

Analysis of the role of PMCT during the COVID-19 pandemic: A systematic review

“…[ 23 , 29 , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] ]. The results of our systematic review are reported in Table I in chronological sequence.…”

“…From the 20 papers, information about 515 cases with SARS-CoV-2 Real-time PCR (RTPCR) positivity and examined through PMCT were available. Seventeen papers [ 29 , [31] , [32] , [33] , [34] , [35] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [46] , [47] , [48] ] provided detailed information about cases. All cases regarded adults.…”

“…Of the 515 cases examined, 289 cases underwent autopsy from 14 articles [ 29 , [31] , [32] , [33] , [34] , [35] , 37 , [39] , [40] , [41] , 44 , [46] , [47] , [48] ], 234/289 of the study of Fitzek et al [39] . In one paper of Silva et al [43] , although the 5 cases presented were not autopsied, they underwent ultrasonography (US) guided biopsies of major organs including the lungs, and histopathological data were available.…”

“…It should be also considered that, as a screening tool, PMCT has been reported to have a high sensitivity, even higher than that of a microbiological testing [28] . Moreover, in 2022, Filograna et al described a correlation between lung PMCT and histopathological findings, finding that PMCT can even suggest the degree of severity of COVID-19 in forensic cases [29] .…”

COVID-19 Medical and Pharmacological Management in the European Countries Compared to Italy: An Overview

“…This autopsy was carried out on 14 February 2020 in Spain [ 91 ]. In Italy, the more recent autoptic examination on COVID-19 cadavers reported in February 2022 on eight cases (five males, three females) showed microthrombi formation and interstitial lymphocytic infiltrates [ 92 ]. Another Italian group examined 29 autopsies on COVID-19 deaths from October 2020 to February 2021, of which 21 patients died in hospitals and 7 outside; they did not report any anatomopathological findings, simply that those cadavers were SARS-CoV-2-positive at a swab test and how much [ 93 ].…”