Analysis of cardiopulmonary findings in COVID-19 fatalities: High incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia
Analysis of cardiopulmonary findings in COVID-19 fatalities: High incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia
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DOI：
10.1016/j.carpath.2020.107263
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发表时间：
2020-11-01
影响因子：
3.7
通讯作者：
Langer, Rupert
中科院分区：
文献类型：
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作者：
Grosse, Claudia;Grosse, Alexandra;Langer, Rupert
自2019年12月被确认以来，由SARS-CoV-2引起的2019冠状病毒病（COVID-19）在全球迅速蔓延，造成了数十年来最大的医学挑战。该研究的目的是根据对14名COVID-19死者进行的（非微创）尸检评估COVID-19的心肺病理学谱。双侧弥漫性肺泡损伤（DAD）。14例患者中有11例（78.6%）存在重叠急性支气管肺炎，并被认为是2例患者死亡的主要原因。一个关键发现是存在血栓性/血栓栓塞性血管闭塞。我们将肺血栓分为5种类型：1。毛细血管微血栓（11/14，78.6%）; 2.中型肺动脉部分机化血栓，血管完全闭塞; 3.中型肺动脉中的非机化血栓，未完全填充血管腔，可能代表血栓栓塞而非血栓形成; 4.骨髓栓子（1/14，7.1%）;和5.脓毒性肺血栓栓塞（1/14，7.1%）。14例患者中有5例（35.7%）在中型动脉中观察到肺血栓，导致肺梗死和/或肺出血。所有患者均有慢性心脏病证据，包括心肌肥厚（13/14，92.9%）、轻度至显著冠状动脉粥样硬化（14/14，100%）和局灶性心肌纤维化（3/14，21.4%）。3例（21.4%）患者的并发死亡原因为急性心肌梗死，1例（7.1%）ATTR阳性心脏淀粉样变性患者存在显著的心脏肥大（心脏重量750 g）。尸检结果证实，COVID-19是一种全身性疾病，主要累及肺部，增加了心脏和血管并发症的风险，包括急性心肌损伤和血栓/血栓栓塞事件。继发性急性支气管肺炎是COVID-19患者的常见并发症，可能是死亡的主要原因。(C)2020由Elsevier Inc.出版。
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. (C) 2020 Published by Elsevier Inc.