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Review
. 2021 Mar:234:151657.
doi: 10.1016/j.aanat.2020.151657. Epub 2020 Dec 3.

Lesions in the lungs of fatal corona virus disease Covid-19

Colya N Englisch  1 , Thomas Tschernig  2 , Fidelis Flockerzi  3 , Carola Meier  1 , Rainer M Bohle  3
Affiliations
Review

Lesions in the lungs of fatal corona virus disease Covid-19

Colya N Englisch et al. Ann Anat. 2021 Mar.

Abstract

The corona virus outbreak in Wuhan, China, at the end of 2019 has rapidly evolved into a pandemic which is still virulent in many countries. An infection with SARS-CoV-2 can lead to corona virus disease (Covid-19). This paper presents an overview of the knowledge gained so far with regard to histopathological lung lesions in fatal courses of Covid-19. The main findings were diffuse alveolar damage and micro-angiopathies. These included the development of hyaline membranes, thrombi, endothelial inflammation, haemorrhages and angiogenesis. Overall, the vessel lesions seemed to be more lethal than the diffuse alveolar damage. There was obvious hyperreactivity and hyperinflammation of the cellular immune system. An expanded T-cell memory may explain the increased risk of a severe course in the elderly.

Keywords: Angiogenesis; Covid-19; Diffuse alveolar damage; Hyaline membranes; Lung lesions; Pathology; Perivascular inflammation; SARS-CoV-2; Thrombi.

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Figures

Fig. 1
Fig. 1
This figure presents examples of lung histopathology from patients who died of Covid-19 (H&E staining). A Covid-19 lung disease: Lymphocytic infiltration of alveolar septae, indicating endothelitis (HE, original magnification x10) B Covid-19 lung disease: Diffuse alveolar damage with desquamative interstitial pneumonia pattern and alveolar fibrin deposits (arrow) (HE, original magnification x10) C Covid-19 lung disease: Nonspecific interstitial pneumonia (NSIP)-like pattern with diffuse cellular thickening of alveolar septae (HE, original magnification x10) D Covid-19 lung disease: Post inflammatory intimal hyperplasia of a muscular pulmonary artery, diffuse alveolar damage and atelectatic obliteration (arrow) (HE, original magnification x10) E Covid-19 lung disease: Acute alveolar haemorrhage and diffuse alveolar damage (HE, original magnification x20) F Covid-19 lung disease: Thrombus and loss of endothelium (arrow) in a mid-sized muscular pulmonary artery (HE, original magnification x10) G Covid-19 lung disease: Fibrin-rich thrombus and loss endothelium (arrow) in a small muscular pulmonary artery (HE, original magnification x20)
See this image and copyright information in PMC

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