Introduction
Methods
Results
N° of Cases | Complete autopsy | Minimally invasive autopsy | Histology | Immunohistochemistry | Electron microscopy | Post-mortem imaging | |
---|---|---|---|---|---|---|---|
Xu et al | 1 | - | 1 | 1 | Not reported | Not reported | Not reported |
Zhang et al | 1 | - | 1 | 1 | 1 | Not reported | Not reported |
Dolhnikoff et al | 10 | - | 10 | 10 | Not reported | Not reported | Not reported |
Yao et al | 3 | - | 3 | 3 | 3 | 3 | Not reported |
Tian et al | 4 | - | 4 | 4 | 1 (in a case with CLL) | Not reported | Not reported |
Duarte-Neto et al | 10 | - | 10 | 10 | 10 | Not reported | Not reported |
Ramon y Cajal Hospital | 1 | - | 1 | 1 | 1 | Not reported | Not reported |
Magro et al | 2 (5 including in life biopsies) | - | 2 | 2 | 2 | Not reported | Not reported |
Su et al | 26 | 26 | - | 26 | 26 | 26 | Not reported |
Barton et al | 2 | 2 | - | 2 | 2 | Not reported | 2 (full body a-p radiographs) |
Grimes et al | 2 | 2 | - | 2 | Not reported | 2 | Not reported |
Varga et al | 2 (3 including 1 intestine resection) | 2 | - | 3 | Not reported | 1 | Not reported |
Bradley et al | 12 | 5 | 7 | 12 | Not reported | 12 | Not reported |
Paniz-Mondolfi et al | 1 | Not specified | Not specified | 1 | Not reported | 1 | Not reported |
Lacy et al | 1 | 1 | - | 1 | Not reported | Not reported | Not reported |
Konopka et al | 1 | 1 | - | 1 | Not reported | Not reported | Not reported |
Prilutskiy et al | 4 | 4 | - | 4 | 4 | Not reported | Not reported |
Yan et al | 1 | 1 | - | 1 | 1 | 1 | Not reported |
Fitzek et al | 1 | 1 | - | 1 | Not reported | Not reported | 1 (PMCT) |
Edler et al | 80 | 80 | - | 12 | Not reported | Not reported | 80 (PMCT) |
Bryce et al | 67 | 67 | - | 25 | Not specified | Not specified | Not reported |
Menter et al | 21 | 17 | 4 | 21 | 11 | 2 | Not reported |
Remmelink et al | 17 | 17 | - | 17 | 17 | Not reported | Not reported |
Wichmann et al | 12 | 12 | - | 12 | 12 | 12 (only lung samples) | 10 (PMCT) |
Schaller et al | 10 | 10 | - | 10 | Not reported | Not reported | Not reported |
Aguiar et al | 1 | 1 | - | 1 | 1 | Not reported | 1 (PMCT) |
Fox et al | 10 | 10 | - | 10 | 10 | 10 | Not reported |
Carsana et al | 38 | 38 | - | 38 | On the most representative areas of randomly selected cases | 10 | Not reported |
Total | 341 | 297 | 44 | 232 | 101 | 80 | 94 (2 RX, 92 PMCT) |
Minimally invasive autopsies
Complete autopsies
Minimally invasive autopsies | N° of Cases | Average age | Sex | Positive swab | Comorbidities | Cause of death | Main macroscopic pulmonary findings | Main microscopic pulmonary findings | Other findings |
---|---|---|---|---|---|---|---|---|---|
Xu et al | 1 | 50 y | 1 male | 1 | Not reported | COVID-19 | - | DAD with hyaline membranes, oedema, inflammatory interstitial infiltration | Hepatic microvescicular steatosis, few cardiac inflammatory infiltrations |
Zhang et al | 1 | 72 y | 1 male | 1 | Diabetes mellitus, hypertension | COVID-19 | - | Organizing DAD, fibrinous exudate, interstitial fibrosis, chronic inflammatory infiltrates | - |
Dolhnikoff et al | 10 | 67.8 y (range 33–83) | 5 male, 5 female | 10 (not directly reported) | 7/10 patients had comorbidities: hypertension, diabetes mellitus, ischemic heart disease, chronic obstructive pulmonary disease | COVID-19 | - | Diffuse exudative and proliferative DAD, foci of alveolar haemorrhage, little lymphocytic infiltration, viral cytopathic damage of epithelium of alveoli and small airways, fibrin microthrombi in small pulmonary arterioles with a large number of megakaryocytes within pulmonary capillaries; in six cases, secondary bacterial pneumonia | Rare small fibrinous thrombi in glomerular and dermal vessels |
Yao et al | 3 | Not reported | Not reported | 3 | Not reported | COVID-19 | - | DAD, inflammatory interstitial infiltration (macrophages and CD4-positive T cells), hyaline thrombi in small vessels, focal haemorrhage, pulmonary interstitial fibrosis | Spleen had less lymohocytes and necrosis; features of other chronic diseases in other organs |
Tian et al | 4 | 59–81 y | 3 male, 1 female | 4 (not directly reported) | At least one of: CLL, cirrhosis, hypertension, diabetes, renal transplantation | COVID-19 | - | DAD, hyaline membranes, type II pneumocytes activation, fibrin cluster and fibroblastic proliferation, congestion, haemorrhages | Not specific changes, sinusoidal dilatation in hepatic tissue, irregular shaped myocardium with no signs of myocarditis |
Duarte-Neto et al | 10 | 69 y (range 33–83) | 5 male, 5 female | 9 positive at nasopharyngeal swab and/or lung tissue | Hypertension, diabetes mellitus, chronic ischemic cardiopathy | Not reported | - | Exudative/proliferative DAD, cytopathic respiratory epithelium damage, fibrinous thrombi within alveolar arterioles (eight cases), abundance of alveolar megakaryocytes | Comorbidity-associated findings; shock signs; other findings: perivascular mononuclear infiltration of the skin in eight cases; myositis in two cases; orchitis in two cases; small vessels endothelial changes; microthrombi in various organs |
Ramon y Cajal Hospital | 1 | 54 y | 1 male | 1 in life nasopharyngeal swab | Hypertension, gout, migraine, obstructive sleep apnea, obesity | Not reported | Heavy, firm and congested lungs | Minimal septal thickening and capillary congestion, rare mononuclear inflammatory infiltrate, alveolar cell desquamation, pneumocyte hyperplasia with cytopathic changes; diffuse exudative DAD with hyaline membranes and organizing DAD, platelet thrombi in small and medium vessels | Kidney cortical necrosis |
Magro et al | 2 | 62 and 73 y | 2 male | 2 in life swab | In one case: coronary artery disease, diabetes mellitus, heart failure, prior treatment for hepatitis C virus infection, end-stage renal disease; the other case: obesity, prediabetes | Respiratory failure (not directly reported) | Congested lungs with hemorraghes | Hemorrhagic pneumonitis, septa congestion and fibrin deposition, in one case some evidence of DAD | Not reported |
Complete autopsies | |||||||||
Su et al | 26 | 69 y (range 39–87) | 19 male, 7 female | All | 11/26 hypertension, diabetes mellitus or both, 6/26 tumor in the past, 2/26 chronic kidney disease | COVID-19 | - | - | ATI, red cells aggregation into microvessels of the kidneys |
Barton et al | 2 | 59,5 y (range 42–77) | 2 male | Both (post-mortem, nasopharyngeal and lung tissue swabs, + lung parenchyma for microbiologic cultures) | One of them: hypertension, cardiovascular disorder (autopsy finding), remote deep vein thrombosis and obesity (bmi 31,8); the other one: myotonic muscular dystrophy and obesity (bmi 31,3) | One case: COVID-19; coronary artery disease as “other contributing factors”; the other case: complications of hepatic cirrhosis; muscular dystrophy, aspiration pneumonia and COVID 19 as “other contributing factors” | Heavy lungs, red to maroon in color, edematous parenchyma that had diffusely firm consistency without focal lesions | In one case: DAD in the acute stage with numerous hyaline membranes and without interstitial organization; thrombi within a few small pulmonary artery branches; congestion and edema fluid focally; mucosal edema within the bronchial mucosa. In the other case: foci of acute bronchopneumonia along with rare aspirated food particles. In both immunohistochemistry showed CD3-, CD4 and CD8-positive T-lymphocytes | Not reported |
Grimes et al | 2 | Middle-aged | 2 male | Both in life nasopharyngeal swabs | Well-controlled hypertension in one case; asthma, hypertension, HIV-infection under antiretroviral therapy in the other case | COVID-19 complicated by pulmonary thromboembolism (not directly reported as the cause of death) | Pulmonary thromboembolism; bilateral pulmonary consolidation | Confirmed thromboembolism (Zhan lines); viral inclusion within the pneumocytes; fibrin inside and outside capillaries alongside platelet thrombi | In both cases deep vein thrombosis; cardiomegaly and left ventricular hypertrophy |
Varga et al | 3 | 58–71 y | 2 male, 1 female | 2 in life swab, for the third positive swab is not directly reported | Kidney transplantation, coronary arteries disease, hypertension in one case; hypertension, obesity, diabetes mellitus in the other case | 1 mesenteric ischemia, 1 multi organ failure, 1 still alive | Not reported | DAD, vessels endothelitis | Small bowel mucosa ischemia alongside with endothelitis of various districts. Viral inclusion in the kidney transplants |
Bradley et al | 12 | 70.4 y (range 42–84) | Not reported | All in life or post-mortem | All patients had significant comorbidities: hypertension, chronic kidney diseas, obstructive sleep apnea, metabolic disease were the most common | COVID-19 | Heavy, edematous lungs with intraparenchymal hemorrhages in one case. In two cases pulmonary emboli were found | DAD at acute or organizing stage with reactive type II pneumocytes; focal areas of acute bronchiolitis and bronchopneumonia in two cases. Viral particles were detected in the lungs and trachea | Non-specific chronic damage of some organs at gross examination; in one case there was also acute tubular injury; some cases showed periportal lymphocytic inflammation. Viral particles were detected in the kidney and large intestines |
Paniz-Mondolfi et al | 1 | 74 y | 1 male | 1 in life | Parkinson’s disease | Not reported | - | - | Viral particles in the frontal lobe and endothelial cells |
Lacy et al | 1 | 58 | 1 female | 1 post-mortem bronchial swab | Type 2 diabetes mellitus, obesity (BMI 38), hyperlipidemia, hypertension, asthma, chronic lower extremity swelling and ulceration | COVID-19; contributory factors: type 2 diabetes mellitus, hypertension, obesity | Heavy, firm, and oedematus lungs, with some hemorrhage areas and thick mucus in the airways. Enlarged mediastinal lymph nodes | Oedema, hyaline membranes, mild mononuclear infiltrates of the septae, desquamated hyperplastic pneumocytes alongside multinucleated cells; no viral inclusion or cytopathic changes | Hepatic steatosis in a contest of congestion and central lobular pallor; mesangial sclerosis |
Konopka et al | 1 | 37 y | 1 male | 1 in life swab | Asthma and type 2 diabetes mellitus | COVID-19 | Heavy lung with mucus within the airways | Chronic asthmatic alterations of the airways; DAD, fibrinous airspace exudate, and rare fibrin thrombi within the small pulmonary vessels | Not reported |
Prilutskiy et al | 4 | 64–91 y | 3 male, 1 female | 4 in life positive swabs | Not reported | COVID-19 | - | Acute exudative DAD | Enlargement of mediastinal and pulmonary hilar lymph nodes, enlarged spleen only in one case |
Yan et al | 1 | 44 y | 1 female | 1 in life nasopharyngeal swab | Obesity, probably unrecognized systemic lupus erythematous | Multi-organ failure | Heavy lungs with signs of pleuritis and enlarged peribronchial lymph nodes | Pulmonary edema and infarction areas; acute lung injury with lymphocytic infiltrates and hyaline membranes DAD; cytopathic damage of pneumocytes alongside viral particles; perivascular lymohocytic cuffing and few lymphocytic infiltration of the vessel wall; fibrin aggregates within blood vessels | Streaking of the right atrial wall myocardial tissue and right ventricle dilatation, microscopically mild myxoid edema, myocyte hypertrophy, focal nuclear pyknosis, CD45 + lymphocytes in the left ventricular papillary muscle; focal acute tubular injury, congestion of peritubular capillaries |
Fitzek et al | 1 | 59 y | 1 male | Oropharyngeal post-mortem swab | Obesity, hypertension, cardiac hypertrophy, cor adiposum (seen at external examination and/or autopsy) | Cardiorespiratory failure with other comorbidities contribution (suspicion of viral pneumonia) | Firm, edematous lungs with greyish-yellow multifocal areas, signs of hemorrhagic tracheobronchitis | DAD with diffuse hyaline membranes, vascular compression and microthrombi, edema, mild lymphocyte infiltration and inflammatory cells within the septa | Congestive cardiomyopathy with cor adiposum as pre-existing pathology |
Edler et al | 80 | 79,2 y (range 52–96) | 46 male, 34 female | All (74 in life swab, 6 post-mortem nasopharyngeal or pulmonary swab) | 38% overweight (13/80 cases) or obesity (17/80 cases), 85% cardiovascular disorder, 55% lung diseases, 35% CNS diseases, 34% kidney diseases, 21% diabetes mellitus, 16% carcinomas/haematological diseases In 2/80 cases no comorbidity identified | 76/80 cases COVID-19 (mostly pneumonia, 8/76 of which complicated by fulminant pulmonary artery embolism, 9/76 by peripheral pulmonary artery embolism); competing causes of death were noticed in 11% of total death;in 4/80 cases virus-independent cause of death | Heavy lungs, with mosaic-like pattern on the surface and evident capillary drawing; firm and fragile tissue | In 8/12 cases DAD at different phases; lymphocytes and plasma cells infiltrate in the small arteries. In 4/12 cases, granulocyte focal confluent bronchopneumonia | deep vein thrombosis (32/80) complicated in 17/32 with vary grade of pulmonary embolism; signs of other chronic diseases; 4/12 shock changes in liver, kidneys or intestine |
Bryce et al | 67 | 69 y (range 34–94) | Not reported | All (in life nasopharyngeal swab) | Hypertension 62.7%, diabetes mellitus 40.3%, coronary artery disease 31.3%, chronic kidney disease 26.7%, asthma 17.9%, heart failure 14.9%, atrial fibrillation 13.4%, obesity 11.9%, co-infections 10.4%, cancer 7.5%, transplantation 7.5%, COPD 6% | COVID-19 | Lung parenchyma appearance ranged from patchy to diffusely consolidated; in one case, multiple cavitary lesions; 4/67 cases showed pulmonary emboli in the main pulmonary arteries | Acute/exudative stage DAD (22 cases), diffuse or focal hyaline membranes, pneumocytes atypia, in two cases intranuclear inclusions. 7 cases acute pneumonia (2/7 extensive and necrotizing); 14 cases showed capillary inflammation; CD61 stains (23 cases) revealed thombi in small and medium pulmonary arteries | Viral particles and replicative structures in the lymph nodes cells; in two cases, patchy mild myocardial interstitial chronic inflammation, in 15 cases patchy epicardial mononuclear infiltrates and predominantly CD4-positive lymphocytes infiltrate associated with small vessel thrombi in three cases and with hemophagocytosisi in another case; bone marrow hemophagocytosis in four cases, spleen hemophagocytosis in nine cases; acute tubular injury in six cases; in five cases liver showed zone 3 ischemic coagulative necrosis, five cases acute outflow obstruction, portal venules thrombi in 15 cases; in six cases microthrombi and acute infarction of the brain |
Menter et al | 21 | 76 y (range 53–96) | 17 male, 4 female | All (in life nasopharyngeal swab, bronchoalveolar lavage or sputum) | All cases had at least one comorbidity. Hypertension and pre-obesity/obesity were the most common; in 14/21 cases renin–angiotensin–aldosterone system-modulating drug intake; in 2 cases immunosuppressive drugs intake; 1 case presented acquired immunodeficiency | Respiratory failure | Heavy, firm and congested lungs | DAD (mainly exudative, in 8/21 cases proliferative), with superimposed bacterial bronchopneumonia in 10/21 cases; capillary congestion; oedema; alveolar haemorrhage; in 5/11 microthrombi in alveolar capillaries | senile cardiac amyloidosis (more prevalent than in past), diffuse shock signs, diffuse acute tubular injury |
Remmelink et al | 17 | 72 y (range 62–77) | 12 male, 5 female | All in life swab (not directly reported) | All except two had at least one comorbidity: hypertension (10/17), diabetes mellitus (9/17), cerebrovascular disease (4/17), coronary artery disease (4/17), solid cancer (4/17) | Respiratory failure (9/17) and multi-organ failure (8/17) | Heavy, firm lungs with haemorrhage areas; thrombi in the large pulmonary arteries in 2/17 cases; | Diffuse exudative DAD (15/17), alongside late-stage DAD, microthrombi in small lung arteries (11/17), lung infarcts (4/17) | 1/17 ischemic enteritis; kidneys often enlarged with pale cortex and petechiae, hemosiderin in the tubules lumen; 2/17 acute myocardial infarctions; |
Wichmann et al | 12 | 73 y (range 52–87) | 9 male, 3 female | All (in life swab) | All cases had at least one comorbidity. In particular coronary heart disease (50%), COPD/asthma (25%), obesity, peripheral artery disease, diabetes mellitus 2, neurodegenerative diseases | COVID -19; in 4/12 complicated by cases massive pulmonary embolism | Heavy, firm and congested lungs, with pleurisy and patchy pattern | DAD, microvascular thromboemboli, capillary congestion, oedema; granulocytic infiltration when bacterial bronchopneumonia | 7/12 cases had bilateral deep vein thrombosis, 4 of them had also massive pulmonary embolism, 3/12 fresh deep venous thrombosis and no PE; not-specific histologic findings of viral infection; shock changes |
Schaller et al | 10 | 79 y (range 64–90) | 7 male, 3 female | All (at hospital admission and post-mortem) | All cases had at least one comorbidity. In particular cardiovascular disease (most frequent), chronic kidney failure, obesity | COVID -19 | Not reported | Disseminated DAD at different phases, in particular in middle and lower lobes | 1 case with mild lymphocytic myocarditis, 1 case with sings of epicarditis; periportal lymphoplasmacellular infiltration and fibrosis at liver histology |
Aguiar et al | 1 | 31 | 1 female | 1 post-mortem (tracheobronchial swab) | Obesity (BMI 61,2) | COVID-19 | Heavy and firm lungs, with bilateral haemorrhagic oedema | Oedema, DAD with hyaline membranes, focal intraalveolar haemorrhage, no viral inclusions or giant cells. CD3 + Tcell and megakaryocytes in the interstitium | Mild chronic tracheitis and microabscesses in the liver |
Fox et al | 10 | Range 44–78 | Not reported | All (at hospital admission) | All cases had at least one comorbidity. In particular hypertension (most common), type 2 diabetes, obesity. One patient was immunosuppressed | COVID-19 | Heavy lungs (all but one) with diffuse oedema, firm tissue and patchy haemorrhage; thrombi in sections of the peripheral parenchyma | Bilateral DAD (2/10 early exudative phase, 7/10 transition to proliferative phase, 1/10 proliferative to fibrotic phase), thrombosed small vessels with associated haemorrhage | Cardiomegaly and right ventricular dilatation with single myocyte necrosis |
Carsana et al | 38 | 69 y (range 32–86) | 33 male, 5 female | All (at hospital admission) | 9 cases diabetes; 18 cases hypertension; 4 cases past malignancies; 11 cases cardiovascular disorders; 3 cases mild chronic obstructive pulmonary disorders (available data only for 31 subjects) | COVID-19 | Pulmonary oedema and congestion with spotty involvement of the lungs | Acute or intermediate DAD in all cases, with atypical pneumocytes and diffuse peripheral small vessels thrombosis | Not reported |