Context: Respiratory failure appears to be the ultimate mechanism of death in most patients with severe COVID-19 infection. Studies of postmortem COVID-19 lungs largely report diffuse alveolar damage (DAD) and capillary fibrin thrombi, but we have also observed other patterns.

Objective: To report demographic and radiographic features along with macroscopic, microscopic, and microbiologic postmortem lung findings in patients with COVID-19 infections.

Design: Patients with confirmed COVID-19 infection and postmortem examination (3/2020–5/2020) were included. Clinical findings were abstracted from medical records. Lungs were microscopically reviewed independently by 4 thoracic pathologists. Imaging studies were reviewed by a thoracic radiologist.

Results: Eight patients (7 men, 87.5%; median age of 79 years, range, 69–96) died within a median of 17 days (range, 6–100) from onset of symptoms. The median lung weight was 1,220 g (range, 960–1,760); consolidations were found in 5 of 8 (62.5%) patients; gross thromboemboli were noted in one of 8 (12.5%) patient. Histologically, all patients had acute bronchopneumonia, 6 of 8 (75%) patients had also DAD. Two of 8 (25%) patients had aspiration pneumonia in addition. Thromboemboli, usually scattered and rare, were identified in 5 of 8 (62.5%) patients in small vessels and in two of these patients also in pulmonary arteries. Four of (50%) patients had perivascular chronic inflammation. Postmortem bacterial lung cultures were positive in 4 of 8 (50%) patients. Imaging studies (available in 4 patients) were typical (N=2, 50%), indeterminate (N=1, 25%), or negative (N=1, 25%) for COVID-19 infection.

Conclusions: Our study shows that patients infected with COVID-19 not only have DAD but also commonly have acute bronchopneumonia and aspiration pneumonia. These findings are important for management of these patients.

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Author notes

The authors have no relevant financial interest in the products or companies described in this article.