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Pulmonary findings in COVID-19 : radiology correlates with the histopathological post-mortem findings in patients with fatal acute disease

Svensson, Ann Mari ; Szekely, Laszlo ; Brunnström, Hans LU orcid ; Kistner, Anna and Ortiz-Villalón, Cristian (2026) In Acta Radiologica 67(5). p.463-474
Abstract

Background: Progressive respiratory failure is the leading cause of death in patients with severe COVID-19. Histopathological findings in acute severe COVID-19 are foremost based on post-mortem findings. On computed tomography (CT), acute COVID-19 pneumonia is characterized by ground-glass opacities (GGOs) and, later, by a crazy-paving pattern (CPP) and consolidations. Purpose: To investigate if CT patterns corresponded to histopathological post-mortem findings. Material and Methods: Eight patients were identified with a chest CT performed between testing positive for COVID-19 and death. CT images, histological slides, and medical records were retrospectively reviewed. The lungs were photographed during the gross investigation to... (More)

Background: Progressive respiratory failure is the leading cause of death in patients with severe COVID-19. Histopathological findings in acute severe COVID-19 are foremost based on post-mortem findings. On computed tomography (CT), acute COVID-19 pneumonia is characterized by ground-glass opacities (GGOs) and, later, by a crazy-paving pattern (CPP) and consolidations. Purpose: To investigate if CT patterns corresponded to histopathological post-mortem findings. Material and Methods: Eight patients were identified with a chest CT performed between testing positive for COVID-19 and death. CT images, histological slides, and medical records were retrospectively reviewed. The lungs were photographed during the gross investigation to ascertain the exact position of the tissue blocks in relation to the relevant anatomical structures. Each slide was compared side by side with the in vivo chest CT pattern on the corresponding site. Results: At CT, the most predominant finding was GGOs, present in all eight cases. CPP was observed in 6/8 (75%) patients, and consolidation in 7/8 (87.5%) patients, both predominantly located in the lower lung zones. In 5 (62.5%) patients, so-called fibrotic-like changes were present. In four patients with CT angiogram, no findings of pulmonary thromboembolism were present. At autopsy, all patients demonstrated macroscopic consolidation, while pleural effusion was seen in 2 (25%) cases. Microscopically, edema was present in all cases, hyaline membranes in 7/8 (87.5%) cases, but no signs of acute interstitial inflammation were observed. Thromboembolic findings were evident in 4 (50%) patients, of whom two were negative on CT and 3 (37.5%) cases had fibrosis. Conclusion: The results demonstrate a clear association between radiological signs of GGO, consolidation and features of organizing pneumonia to microscopical signs of edema and diffuse alveolar damage. However, fibrotic-like changes and thromboembolism in the small vessels had a poorer compliance.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute respiratory distress syndrome, chest computed tomography, diffuse alveolar damage, lung biopsy, organizing pneumonia
in
Acta Radiologica
volume
67
issue
5
pages
12 pages
publisher
SAGE Publications
external identifiers
  • scopus:105033947867
  • pmid:41879101
ISSN
0284-1851
DOI
10.1177/02841851261425663
language
English
LU publication?
yes
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Publisher Copyright: © The Foundation Acta Radiologica 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
id
ed82d77f-f27a-4b79-8bbe-ffd60487b535
date added to LUP
2026-05-27 16:20:02
date last changed
2026-09-18 07:19:28
@article{ed82d77f-f27a-4b79-8bbe-ffd60487b535,
  abstract     = {{<p>Background: Progressive respiratory failure is the leading cause of death in patients with severe COVID-19. Histopathological findings in acute severe COVID-19 are foremost based on post-mortem findings. On computed tomography (CT), acute COVID-19 pneumonia is characterized by ground-glass opacities (GGOs) and, later, by a crazy-paving pattern (CPP) and consolidations. Purpose: To investigate if CT patterns corresponded to histopathological post-mortem findings. Material and Methods: Eight patients were identified with a chest CT performed between testing positive for COVID-19 and death. CT images, histological slides, and medical records were retrospectively reviewed. The lungs were photographed during the gross investigation to ascertain the exact position of the tissue blocks in relation to the relevant anatomical structures. Each slide was compared side by side with the in vivo chest CT pattern on the corresponding site. Results: At CT, the most predominant finding was GGOs, present in all eight cases. CPP was observed in 6/8 (75%) patients, and consolidation in 7/8 (87.5%) patients, both predominantly located in the lower lung zones. In 5 (62.5%) patients, so-called fibrotic-like changes were present. In four patients with CT angiogram, no findings of pulmonary thromboembolism were present. At autopsy, all patients demonstrated macroscopic consolidation, while pleural effusion was seen in 2 (25%) cases. Microscopically, edema was present in all cases, hyaline membranes in 7/8 (87.5%) cases, but no signs of acute interstitial inflammation were observed. Thromboembolic findings were evident in 4 (50%) patients, of whom two were negative on CT and 3 (37.5%) cases had fibrosis. Conclusion: The results demonstrate a clear association between radiological signs of GGO, consolidation and features of organizing pneumonia to microscopical signs of edema and diffuse alveolar damage. However, fibrotic-like changes and thromboembolism in the small vessels had a poorer compliance.</p>}},
  author       = {{Svensson, Ann Mari and Szekely, Laszlo and Brunnström, Hans and Kistner, Anna and Ortiz-Villalón, Cristian}},
  issn         = {{0284-1851}},
  keywords     = {{Acute respiratory distress syndrome; chest computed tomography; diffuse alveolar damage; lung biopsy; organizing pneumonia}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{463--474}},
  publisher    = {{SAGE Publications}},
  series       = {{Acta Radiologica}},
  title        = {{Pulmonary findings in COVID-19 : radiology correlates with the histopathological post-mortem findings in patients with fatal acute disease}},
  url          = {{http://dx.doi.org/10.1177/02841851261425663}},
  doi          = {{10.1177/02841851261425663}},
  volume       = {{67}},
  year         = {{2026}},
}