Autopsy findings in COVID-19-related deaths: a literature review
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REVIEW
Autopsy findings in COVID-19-related deaths: a literature review Aniello Maiese 1 & Alice Chiara Manetti 1 & Raffaele La Russa 2 & Marco Di Paolo 1 & Emanuela Turillazzi 1 & Paola Frati 2 & Vittorio Fineschi 2 Accepted: 3 September 2020 # The Author(s) 2020
Abstract Although many clinical reports have been published, little is known about the pathological post-mortem findings from people who have died of the novel coronavirus disease. The need for postmortem information is urgent to improve patient management of mild and severe illness, and treatment strategies. The present systematic review was carried out according to the Preferred Reporting Items for Systematic Review (PRISMA) standards. A systematic literature search and a critical review of the collected studies were conducted. An electronic search of PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EMBASE) from database inception to June 2020 was performed. We found 28 scientific papers; the total amount of cases is 341. The major histological feature in the lung is diffuse alveolar damage with hyaline membrane formation, alongside microthrombi in small pulmonary vessels. It appears that there is a high incidence of deep vein thrombosis and pulmonary embolism among COVID-19 decedents, suggesting endothelial involvement, but more studies are needed. A uniform COVID-19 post-mortem diagnostic protocol has not yet been developed. In a time in which international collaboration is essential, standardized diagnostic criteria are fundamental requirements. Keywords COVID-19 . Autopsy . Findings . Pathophysiology
Introduction The outbreak of the new SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has spread all over the world [1], and on 11 March 2020, the World Health Organization declared it a pandemic [2]. COVID-19 (coronavirus disease 2019) has become a challenge for all health care authorities due to an increasing number of severely ill patients, which overloads intensive care units. SARS-CoV-2 infection causes the release of a significant amount of pro-inflammatory cytokines that aggravate interstitial pneumonia and acute respiratory distress syndrome (ARDS) [3–6]. This clinical picture evolves into viral sepsis
* Vittorio Fineschi [email protected] 1
2
Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, PI, Italy Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, RM, Italy
with prominent hypercoagulability and multiorgan dysfunction [7–11]. Autopsy findings are crucial to gaining a better understanding of how this infection affects the human body, similar to how these findings are important to understanding other infectious diseases [12–14]. Histopathological evidence of damage to the surface layers of airway epithelial cells and massive lung involvement with diffuse alveolar damage (DAD) and microvascular thrombi have b
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