Pathology for COVID-19 Infectious Diseases

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PATHOLOGY from Infectious Diseases Team

COVID-19 Infectious Diseases by Isaac Solomon, MD, PhD

Severe Acute Respiratory Syndrome Coronavirus 2

1-p1-id — This illustration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shows surface spikes (red), giving a halo appearance incorporated into the name "corona." (Courtesy A. Eckert, MS and D. Higgins, MAMS.)

Ultrastructural Features

2-p1-2-pathology-id — This transmission electron micrograph shows spherical extracellular particles with surface spikes and cross sections through the viral genome (black dots), features characteristic of SARS-CoV-2. (Courtesy C. Goldsmith, CDC and A. Tamin, CDC.)

Chest X-Ray

3-p1-3-pathology-id — This portable chest X-ray shows parenchymal opacities with asymmetric distribution, consolidation in the right perihilar region, and opacity in left lung base, findings consistent with COVID-19 pneumonia.

Histopathologic Features

4-p1-4-pathology-id — This autopsy lung section shows hyaline membranes, interstitial edema and inflammation, and squamous metaplasia, features consistent with diffuse alveolar damage. Confirmation of SARS-CoV-2 infection requires IHC, ISH, or PCR. (Courtesy R. Padera, Jr., MD, PhD.)

Gross Features

5-p1-5-pathology-id — This section of lung from a fatal case of COVID-19 shows areas of red congested and edematous parenchyma, consistent with diffuse alveolar damage. (Courtesy R. Padera, Jr., MD, PhD.)

Hyaline Membranes

6-p5-2-pathology-id — Early histologic findings in COVID-19 pneumonia include eosinophilic hyaline membranes consistent with exudative (acute) diffuse alveolar damage. (Courtesy R. Padera, Jr., MD, PhD.)

Interstitial Inflammation and Edema

7-p5-3-pathology-id — COVID-19 pneumonia includes variable amounts of interstitial and perivascular chronic inflammation and edema. (Courtesy R. Padera, Jr., MD, PhD.)

Fibrin Thrombi

8-p5-4-pathology-id — Fibrin thrombi involving small vessels are occasionally present in COVID-19 pneumonia. (Courtesy R. Padera, Jr., MD, PhD.)

Squamous Metaplasia

9-p5-5-pathology-id — Squamous metaplasia is frequently present in the lungs in COVID-19 pneumonia, and can exhibit significant cytologic atypia. (Courtesy R. Padera, Jr., MD, PhD.)

Multinucleated Giant Cells

10-p5-6-pathology-id — Multinucleated giant cells with prominent reactive-appearing nucleoli are variably present in COVID-19 pneumonia. (Courtesy R. Padera, Jr., MD, PhD.)

Cytoplasmic Inclusions

11-p6-1-pathology-id — Multinucleated giant cells may contain basophilic cytoplasmic inclusions of unclear etiology. (Courtesy R. Padera, Jr., MD, PhD.)

Lymphophagocytosis

12-p6-2-pathology-id — A reactive histiocyte is present containing an engulfed lymphocyte that should not be confused with a viral inclusion. (Courtesy R. Padera, Jr., MD, PhD.)

Proliferative (Organizing) Phase

13-p6-3-pathology-id — Later changes in COVID-19 pneumonia include proliferation of pneumocytes and fibroblasts to form loose organizing connective tissue. (Courtesy R. Padera, Jr., MD, PhD.)

Fibroblast Proliferation

14-p6-4-pathology-id — Fibroblast proliferation and collagen production in alveolar spaces reflects organized alveolar damage. (Courtesy R. Padera, Jr., MD, PhD.)

Large Airway Involvement

15-p6-5-pathology-id — Large airways in COVID-19 occasionally show lymphocytic bronchitis/bronchiolitis with reactive epithelial changes and occasional intraepithelial neutrophils. (Courtesy R. Padera, Jr., MD, PhD.)

Bacterial Bronchopneumonia

16-p6--pathology-id — Coinfections with bacteria, fungi, and other respiratory viruses are common with COVID-19. This section shows multiple collections of basophilic bacteria embedded in intraalveolar neutrophils. (Courtesy R. Padera, Jr., MD, PhD.)

Chest CT

d1-pathology-id — This chest CT from a patient positive for COVID-19 shows bilateral upper and lower lobe peribronchial ground-glass and consolidative opacities.

RT-PCR Testing

d2-pathology-id — RT-PCR of respiratory specimens is the most common test used for confirmation of COVID-19. (Courtesy CDC.)

SARS Histopathology

d3-pathology-id — Section of a lung in a patient with SARS shows diffuse alveolar damage and a multinucleated giant cell with no conspicuous viral inclusions , findings similar to those reported in COVID-19. (Courtesy S. Zaki, MD, PhD.)

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