COVID-19 autopsies of Istanbul

Abstract

Background/aims: The aim of this study is to share autopsy findings of COVID-19-positive cases and autopsy algorithms for safely handling of suspicious bodies during this pandemic.

Methods: COVID-19-positive cases of Istanbul Morgue Department were retrospectively analyzed. Sampling indications for PCR tests in suspicious deaths, macroscopic and microscopic findings obtained in cases with positive PCR tests were evaluated.

Results: In the morgue department, 345(25.8%) of overall 1336 autopsy cases were tested for COVID-19. PCR test was found positive in 26 cases. Limited autopsy procedure was performed in 7 cases, while the cause of death was determined by external examination in the remaining 19 cases. Male-to-female ratio was found 3.3:1 and mean age was 60.0 ± 13.6 among all PCR-positive cases. Cause of death was determined as viral pneumonia in fully autopsied cases. Most common findings were sticky gelatinous fluid in cavities and firm and swollen lungs, varying degrees of consolidation. In microscopy, diffuse alveolar epithelial damage, type-II pneumocyte hyperplasia, hyaline membrane formation, fibrinous exudate, and fibrinous plaques in the alveoli were the most common findings.

Conclusions: In COVID-19 autopsies, pulmonary findings were found to be prominent and the main pathology was pneumonia. Older age and findings of chronic diseases indicate that the cases were in the multirisk group in terms of COVID-19 mortality.

Keywords: Autopsy; COVID-19; Pulmonary findings; Risk factors.

Fig. 1

Tracheal swab collection

Fig. 2

COVID-19 preliminary assessment diagram of Council of Forensic Medicine

Fig. 3

In situ macroscopical lung findings. A Sticky gelatinous fluid on the contours of the lungs. B Excessive edema. C Dilated vessels and consolidation on the cut surfaces. D Consolidation, red hepatization

Fig. 4

A Type II pneumocyte hyperplasia with reactive cytologic atypia. B Alveoli wall covered with hyaline membranes and type II pneumocytes. C Fibrin thrombi in vessel lumens

Fig. 5

Case #2. A Focal lymphocytic infiltration of myocardium, without myocyte necrosis (H&E, × 400). B DAD with hyaline membrane formation, paucicellular interstitial lymphocytic infiltration, edema and congestion, no microvascular thrombosis (H&E, × 200). C Granulocytic infiltration of focal bronchopneumonia associated with DAD (H&E, × 400). D Prominent proliferation of type II pneumocytes, subacute phase of DAD (H&E, × 400). E Fibrotic plugs in airspaces, subacute phase of DAD (H&E, × 400)

Fig. 6

Case #3. A Focal area of myocardial scar (H&E, × 200). B Steatosis of Hepatocytes (H&E, × 200). C Patchy lymphocytic interstitial infiltration and fibrinous exudate in the alveoli. This image was taken from one of the few areas where inflammation was obvious. In other areas, infiltration was sparse or absent (H&E, × 400). D Organizing subdural hemorrhage (H&E, × 200)