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Respirology: Local lung tissues with normal CT findings in COVID-19 patients may also have lesions

 Last Update: 2021-07-29
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The continuing pandemic of COVID-19 poses a global challenge, with more than 135 million confirmed cases and more than 2.
9 million deaths (Weekly report from the World Health Organization on April 11)
.

The clinical manifestations range from mild symptoms such as fever, dry cough, and shortness of breath to the fatal disease that develops into acute respiratory distress syndrome (ARDS).

COVID-19 diagnostic management thrombotic vascular

Kianzad A et al.
proposed for the first time the direct regional correlation between imaging findings and corresponding histological patterns in the autopsy cohort of 8 COVID-19 infected patients
.

The research aims to improve the interpretation of CT manifestations, and the ultimate goal is to provide image-based guidance for diagnosis and treatment strategies

Kianzad A et al.

The study prospectively selected 8 patients with COVID-19 pneumonia confirmed by PCR for autopsy
.

All patients underwent chest CT examination 24-72 hours before death

A freshly resected specimen of the right lung, taken laterally (A)
.

The distance between the tip and the fissure associated with the CT appearance of interest is measured on the CT scan and subsequently in the specimen to achieve exactly the same level (B, C)

A freshly resected specimen of the right lung, taken laterally (A)

Correlation between radiological manifestations and tissue damage manifestations

(A) CT of the right lung showed patchy GGO (zones 1 and 2) and consolidation of surrounding GGO (zones 3 and 4)
.

(B) The corresponding histopathology of patchy GGO (regions 1 and 2) shows prominent microthrombus (arrow) and (C) patchy stage DAD

(A) CT of the right lung showed patchy GGO (zones 1 and 2) and consolidation of surrounding GGO (zones 3 and 4)

(A) CT of the right lung showed clearly demarcated consolidation (area 1) and diffuse GGO (area 2 and 3), accompanied by thickened interlobular septa
.

(B) The corresponding histopathologically clear (arrow) demarcation of consolidation (area 1) shows acute fibrinous and tissue pneumonia (AFOP, scale bar corresponds to 2 mm)

(A) CT of the right lung showed clearly demarcated consolidation (area 1) and diffuse GGO (area 2 and 3), accompanied by thickened interlobular septa

(A) CT of the right lung showed consolidation of the middle lobe with traction bronchiectasis (area 1), and consolidation of the right lower lobe with surrounding GGO (area 2)
.
(B) The corresponding histopathology of the middle lobe with traction bronchiectasis (area 1, scale strip corresponding to 2 mm) shows that DAD is in the hyperplastic stage
.
(C) EVG staining of proliferative DAD in zone 1.
There is no pink collagen deposition in the parenchyma, suggesting that there is no fibrosis, and parenchymal remodeling may be reversible
.
Note the pink collagen in the adventitia of normal blood vessels (green asterisk, scale bar corresponds to 50μm)
.
(D) A large area of hemorrhage (arrow) with surrounding patchy microscopic hemorrhage (asterisk) and DAD exudation phase (arrow, scale bar corresponding to 1 mm) can be seen in the surrounding GGO (zone 2)

(A) CT image of the left lung showing unaffected lung parenchyma (zone 1), patchy GGO (zone 2), peribronchial consolidation (zone 3), and subpleural consolidation (zone 4)
.
b.
Radiologically unaffected lung parenchyma (area 1) shows patchy endotheliitis (arrow)
.
c.
The corresponding histopathology of patchy GGO (zone 2) is flaky hemorrhage d.
The corresponding histopathology of the bronchial perivascular and subpleural areas (zones 2 and 3) is acute exudative pneumonia (bronchial Pneumonia), accompanied by infiltration of neutrophils in the alveolar cavity (arrow, scale equivalent to 50μm)
.
(B)a.
The CT image of the left lung shows that the early patient has unaffected lung parenchymal area (area 1), peribronchial consolidation area (area 2) and subpleural consolidation area (area 3)
.
Corresponding histopathological examination of the unaffected lung parenchyma (area 1) showed early microthrombosis (arrow)
.
c.
The corresponding histopathological examination of the peribronchial consolidation (area 2 and 3) showed that bronchopneumonia has a central distribution of the bronchus and vascular involvement
.
d.
There is thrombus (the scale is equivalent to 50μm)
.

Two main types of imaging were observed: ground glass shadow (GGO) (n=11) and consolidation (n=16)
.
Among the 11 GGO sample areas, diffuse alveolar damage (DAD) was observed in 7 areas
.
In the four areas of GGO, the histology showed vascular injury and thrombosis, with (n=2) or without DAD (n=2)
.
Of the 16 samples from the radioactive consolidation zone, DAD was also observed in 5 of them
.
7 consolidation areas with combined DAD, vascular injury and thrombosis
.
Bronchopneumonia was found in 4 consolidation areas
.
Unexpectedly, in radiologically unaffected lung parenchymal samples, evidence of vascular damage and thrombosis was found
.

For the first time in this study, in an autopsy cohort of 8 COVID-19 patients, the most frequently observed CT findings of the lungs were directly compared with the corresponding histopathological findings
.
The course of the disease and the cause of death vary among patients
.
The study provides a comprehensive and detailed correlation between imaging and pathology, which is valuable for clinical interpretation of chest CT in patients with new coronary pneumonia
.
It proves that the typical CT manifestations of new coronary pneumonia are not strictly related to specific histopathological patterns
.
In addition, regardless of the radiological manifestations, DAD, vascular damage, and thrombosis are common in the lungs infected with new coronary pneumonia
.

New coronary pneumonia The typical CT findings of new coronary pneumonia are not strictly related to specific histopathological patterns
.
In addition, regardless of the radiological manifestations, DAD, vascular damage, and thrombosis are common in the lungs infected with new coronary pneumonia
.
The typical CT findings of new coronary pneumonia are not strictly related to specific histopathological patterns
.
In addition, regardless of the radiological findings, DAD, vascular damage, and thrombosis are common in the lungs infected with new coronary pneumonia
.

The imaging manifestations of GGO and consolidation of COVID-19 are mainly explained by the combination of DAD or DAD with vascular injury and thrombosis .
However, the different typical CT findings in COVID-19 have nothing to do with specific histopathological findings .
Microvascular damage and thrombosis can even occur in radiologically normal lungs .
The imaging manifestations of GGO and consolidation of COVID-19 are mainly explained by the combination of DAD or DAD with vascular injury and thrombosis
.
However, the different typical CT findings in COVID-19 have nothing to do with specific histopathological findings
.
Microvascular damage and thrombosis can even occur in radiologically normal lungs
.

Original source

Kianzad A, Meijboom LJ, Nossent EJ, et al.
COVID-19: Histopathological correlates of imaging patterns on chest computed tomography [published online ahead of print, 2021 Jun 22].
Respirology .
2021;10.
1111/resp.
14101.
doi:10.
1111 /resp.
14101 Kianzad A, Meijboom LJ, Nossent EJ, et al.
COVID-19: Histopathological correlates of imaging patterns on chest computed tomography [published online ahead of print, 2021 Jun 22].
Respirology .
2021;10.
1111/resp.
14101 .
doi:10.
1111/resp.
14101 Respirology leave a message here

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