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Savoia P, Valente Yamada Sawamura M, de Almeida Monteiro RA, Nunes Duarte-Neto A, Morais Martin MDG, Dolhnikoff M, Mauad T, Nascimento Saldiva PH, da Costa Leite C, Ferraz da Silva LF, Cardoso EF. Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method. Eur J Radiol Open 2024; 12:100546. [PMID: 38293283 PMCID: PMC10825618 DOI: 10.1016/j.ejro.2024.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Objectives Performing autopsies in a pandemic scenario is challenging, as the need to understand pathophysiology must be balanced with the contamination risk. A minimally invasive autopsy might be a solution. We present a model that combines radiology and pathology to evaluate postmortem CT lung findings and their correlation with histopathology. Methods Twenty-nine patients with fatal COVID-19 underwent postmortem chest CT, and multiple lung tissue samples were collected. The chest CT scans were analyzed and quantified according to lung involvement in five categories: normal, ground-glass opacities, crazy-paving, small consolidations, and large or lobar consolidations. The lung tissue samples were examined and quantified in three categories: normal lung, exudative diffuse alveolar damage (DAD), and fibroproliferative DAD. A linear index was used to estimate the global severity of involvement by CT and histopathological analysis. Results There was a positive correlation between patient mean CT and histopathological severity score indexes - Pearson correlation coefficient (R) = 0.66 (p = 0.0078). When analyzing the mean lung involvement percentage of each finding, positive correlations were found between the normal lung percentage between postmortem CT and histopathology (R=0.65, p = 0.0082), as well as between ground-glass opacities in postmortem CT and normal lungs in histopathology (R=0.65, p = 0.0086), but negative correlations were observed between ground-glass opacities extension and exudative diffuse alveolar damage in histological slides (R=-0.68, p = 0.005). Additionally, it was found is a trend toward a decrease in the percentage of normal lung tissue on the histological slides as the percentage of consolidations in postmortem CT scans increased (R =-0.51, p = 0.055). The analysis of the other correlations between the percentage of each finding did not show any significant correlation or correlation trends (p ≥ 0.10). Conclusions A minimally invasive autopsy is valid. As the severity of involvement is increased in CT, more advanced disease is seen on histopathology. However, we cannot state that one specific radiological category represents a specific pathological correspondent. Ground-glass opacities, in the postmortem stage, must be interpreted with caution, as expiratory lungs may overestimate disease.
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Affiliation(s)
- Paulo Savoia
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Marcio Valente Yamada Sawamura
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Renata Aparecida de Almeida Monteiro
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Amaro Nunes Duarte-Neto
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Maria da Graça Morais Martin
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Thais Mauad
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Claudia da Costa Leite
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Luiz Fernando Ferraz da Silva
- Department of Pathology, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo, 455, sala 1155, 01246-903, Cerqueira Cesar, São Paulo, SP, Brazil
| | - Ellison Fernando Cardoso
- Department of Radiology, University of Sao Paulo School of Medicine, Institute of Radiology, Rua Doutor Ovidio Pires de Campos, 75, 05403-010, Cerqueira Cesar, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 05652-900, Morumbi, São Paulo, SP, Brazil
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Filograna L, Manenti G, O'Donnell C, Floris R, Oliva A. Potentials of post-mortem CT (PMCT) in paediatric cases related to SARS-CoV-2 infection. Forensic Sci Med Pathol 2023; 19:289-290. [PMID: 36864235 PMCID: PMC9980847 DOI: 10.1007/s12024-023-00600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Laura Filograna
- Area of Diagnostic Imaging, Department of Integrated Care Processes, Fondazione PTV Policlinico Universitario Tor Vergata, University of Rome Tor Vergata, Rome, Italy.
| | - Guglielmo Manenti
- Area of Diagnostic Imaging, Department of Integrated Care Processes, Fondazione PTV Policlinico Universitario Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Chris O'Donnell
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia
- Department of Forensic Medicine, Monash University, Clayton, Australia
| | - Roberto Floris
- Area of Diagnostic Imaging, Department of Integrated Care Processes, Fondazione PTV Policlinico Universitario Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Oliva
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, Rome, Italy
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Grassi S, Arena V, Zedda M, Cazzato F, Cianci R, Gambassi G, Oliva A. What can autopsy say about COVID-19? A case series of 60 autopsies. Leg Med (Tokyo) 2023; 62:102241. [PMID: 36924619 PMCID: PMC10008096 DOI: 10.1016/j.legalmed.2023.102241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Autopsies in SARS-CoV-2 infected cadavers are mainly performed to distinguish patients who died with SARS-CoV-2 infection from those who died of COVID-19. The aim of the current study is to assess the most frequent autopsy findings in patients who died of COVID-19 and to establish an association with clinical records. MATERIALS AND METHODS 60 patients died between April 2020 and March 2021 after SARS-CoV-2 infection underwent a full autopsy performed at Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome). Ante-mortem diagnosis of SARS-CoV-2 infection was microbiologically confirmed. RESULTS 55 (92%) of cases had at least a comorbidity. At microscopic examination, 40 (67%) of the patients presented pulmonary intravascular coagulation with an inflammatory pattern. Pulmonary microangiopathy was a rare finding (n = 8; 13%). Myocardiosclerosis was the main heart finding (n = 44; 73%). Liver involvement with congestion and hypotrophy was found in 33 (55%) of cadavers. Renal tubular epithelial exfoliation (n = 12; 20%) and intravascular coagulation (n = 4; 7%) were frequent observations. During hospitalization 31% of patients (n = 19) developed acute kidney injury (AKI). CONCLUSIONS Lungs and kidneys have been shown to play a pivotal role in COVID-19. The gradual worsening of renal function and AKI might be the result of the progressive collapse of cardiopulmonary system.
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Affiliation(s)
- Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, Florence 50134, Italy; Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vincenzo Arena
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00147, Italy
| | - Massimo Zedda
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Francesca Cazzato
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rossella Cianci
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome 00168, Italy
| | - Giovanni Gambassi
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome 00168, Italy
| | - Antonio Oliva
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Filograna L, Manenti G, Grassi S, Zedda M, Cazzato F, Ryan CP, Arena V, Pascali VL, Colosimo C, Floris R, Oliva A. Virtual autopsy in SARS-CoV-2 breakthrough infection: a case report. FORENSIC IMAGING 2022. [PMCID: PMC9433066 DOI: 10.1016/j.fri.2022.200520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
It is well documented that COVID-19 vaccines are effective tools for limiting the pandemic. Unfortunately, as is true for all vaccines, SARS-CoV-2 infection in vaccinated individuals is still possible. We present an autopsy case of SARS-CoV-2 infection after vaccination (“breakthrough infection”) in an elderly man with several comorbidities where post-mortem CT scan was performed. The death was histologically attributed to cardio-respiratory arrest due to ischemic heart failure related to superinfected COVID-19 pneumonia and pre-existing comorbidities. For the first time in the literature, PMCT imaging related to a fatal, autopsy case of breakthrough SARS-CoV-2 infection is reported. PMCT of the lungs, in accordance with histopathological results, showed few signs of COVID-19 pneumonia, large area of consolidation in the right lower lobe, interpreted as bronco-pneumonic focus, and hypostasis. These findings were well-correlated with the previously reported literature about both PMCT and clinical CT imaging of the lungs in non-vaccinated individuals with early COVID-19 pneumonia and about pulmonary clinical CT imaging in COVID-19 pneumonia in breakthrough SARS-COV-2 infections. Further studies are needed to cover the whole spectrum of PMCT lung imaging in fatal breakthrough SARS-CoV-2 infection, however, this case represent a first step for exploring this difficult challenge during SARS-CoV-2 pandemic using virtual autopsy.
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