With the COVID-19 pandemic having reached tremendous proportions, post-mortem series are under the limelight to explain many of the peculiar clinical findings. Pathological descriptions of disease are fundamental for understanding pathogenetic features and might inform new treatments. Indeed, the widely discussed identification of thrombosis in patients with COVID-19 has garnered much interest, and has resulted in new treatment strategies, with anticoagulants now part of patient management. Between April 16, and May 4, 2020, we collected lung tissue using a cryobiopsy approach from eight patients in our institution who died in intensive care with COVID-19 (unpublished). Patients died after a mean disease duration of 31·3 days (SD 8·3), a much longer duration of illness than reported in a previous study by Carsana et al, in which the mean time from symptom onset to death was 16 days (SD 6). Tissues obtained by cryobiopsy are comparable to specimens from live patients as the procedure is done within 30 min of death. We observed marked fibrotic lung parenchymal remodelling, characterised by fibroblast proliferation, airspace obliteration, and micro-honeycombing in many of the available cryobiopsies. Presumably, the fibrotic pathological findings are unlikely to regress in patients with severe COVID-19 who survive, although prospective studies are necessary to identify long-term functional impairment.
Lung fibrosis: an undervalued finding in COVID-19 pathological series
Grillo F.;Ball L.;Mastracci L.;Fiocca R.
2021-01-01
Abstract
With the COVID-19 pandemic having reached tremendous proportions, post-mortem series are under the limelight to explain many of the peculiar clinical findings. Pathological descriptions of disease are fundamental for understanding pathogenetic features and might inform new treatments. Indeed, the widely discussed identification of thrombosis in patients with COVID-19 has garnered much interest, and has resulted in new treatment strategies, with anticoagulants now part of patient management. Between April 16, and May 4, 2020, we collected lung tissue using a cryobiopsy approach from eight patients in our institution who died in intensive care with COVID-19 (unpublished). Patients died after a mean disease duration of 31·3 days (SD 8·3), a much longer duration of illness than reported in a previous study by Carsana et al, in which the mean time from symptom onset to death was 16 days (SD 6). Tissues obtained by cryobiopsy are comparable to specimens from live patients as the procedure is done within 30 min of death. We observed marked fibrotic lung parenchymal remodelling, characterised by fibroblast proliferation, airspace obliteration, and micro-honeycombing in many of the available cryobiopsies. Presumably, the fibrotic pathological findings are unlikely to regress in patients with severe COVID-19 who survive, although prospective studies are necessary to identify long-term functional impairment.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.