{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:55:23Z","timestamp":1792688123828,"version":"4.5.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Although diffuse alveolar damage, a subtype of acute lung injury (ALI), is the most common microscopic pattern in coronavirus disease 2019 (COVID-19), other pathologic patterns have been described. The aim of the study was to review autopsies from COVID-19 decedents to evaluate the spectrum of pathology and correlate the results with clinical, laboratory, and radiologic findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive and quantitative review from 40 postmortem examinations was performed. The microscopic patterns were categorized as follows: \u201cmajor\u201d when present in more than 50% of cases and \u201cnovel\u201d if rarely or not previously described and unexpected clinically.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three major pulmonary patterns were identified: ALI in 29 (73%) of 40, intravascular fibrin or platelet-rich aggregates (IFPAs) in 36 (90%) of 40, and vascular congestion and hemangiomatosis-like change (VCHL) in 20 (50%) of 40. The absence of ALI (non-ALI) was novel and seen in 11 (27%) of 40. Compared with ALI decedents, those with non-ALI had a shorter hospitalization course (P = .02), chest radiographs with no or minimal consolidation (P = .01), and no pathologically confirmed cause of death (9\/11). All non-ALI had VCHL and IFPAs, and clinically most had cardiac arrest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Two distinct pulmonary phenotypic patterns\u2014ALI and non-ALI\u2014were noted. Non-ALI represents a rarely described phenotype. The cause of death in non-ALI is most likely COVID-19 related but requires additional corroboration.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ajcp\/aqaa156","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T11:17:55Z","timestamp":1596194275000},"page":"748-760","source":"Crossref","is-referenced-by-count":91,"title":["Forty Postmortem Examinations in COVID-19 Patients"],"prefix":"10.1093","volume":"154","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4892-810X","authenticated-orcid":false,"given":"Simona","family":"De Michele","sequence":"first","affiliation":[{"name":"Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mine M","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Katsyv","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Salvatore","sequence":"additional","affiliation":[{"name":"Department of Radiology, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L","family":"Dzierba","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles C","family":"Marboe","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Brodie","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina M","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine K","family":"Garcia","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3133-9886","authenticated-orcid":false,"given":"Anjali","family":"Saqi","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"2020110406312327200_CIT0001","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1093\/ajcp\/aqaa062","article-title":"COVID-19 autopsies, Oklahoma, USA","volume":"153","author":"Barton","year":"2020","journal-title":"Am J Clin Pathol."},{"key":"2020110406312327200_CIT0002","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/S2213-2600(20)30076-X","article-title":"Pathological findings of COVID-19 associated with acute respiratory distress syndrome","volume":"8","author":"Xu","year":"2020","journal-title":"Lancet Respir Med."},{"key":"2020110406312327200_CIT0003","doi-asserted-by":"crossref","first-page":"629","DOI":"10.7326\/M20-0533","article-title":"Histopathologic changes and SARS-CoV-2 immunostaining in the lung of a patient with COVID-19","volume":"172","author":"Zhang","year":"2020","journal-title":"Ann Intern Med."},{"key":"2020110406312327200_CIT0004","article-title":"Early histologic findings of pulmonary SARS-CoV-2 infection detected in a surgical specimen [published online April 30, 2020]","author":"Pernazza","journal-title":"Virchows Arch."},{"key":"2020110406312327200_CIT0005","article-title":"Postmortem lung findings in an asthmatic patient with coronavirus disease 2019 [published online April 28, 2020]","author":"Konopka","journal-title":"Chest"},{"key":"2020110406312327200_CIT0006","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endotheliitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet."},{"key":"2020110406312327200_CIT0007","volume-title":"Pulmonary and cardiac pathology in Covid-19: the first autopsy series from New Orleans","author":"Fox","year":"2020"},{"key":"2020110406312327200_CIT0008","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.jtho.2020.02.010","article-title":"Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer","volume":"15","author":"Tian","year":"2020","journal-title":"J Thorac Oncol."},{"key":"2020110406312327200_CIT0009","doi-asserted-by":"crossref","DOI":"10.1038\/s41379-020-0536-x","article-title":"Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies","author":"Tian","year":"2020;33:1007-1014","journal-title":"Mod Pathol."},{"key":"2020110406312327200_CIT0010","doi-asserted-by":"crossref","DOI":"10.1016\/j.trsl.2020.04.007","article-title":"Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases","author":"Magro","year":"2020;220:1-13","journal-title":"Transl Res."},{"key":"2020110406312327200_CIT0011","article-title":"Time to consider histologic pattern of lung injury to treat critically ill patients with COVID-19 infection [published online April 23, 2020]","author":"Copin","journal-title":"Intensive Care Med."},{"key":"2020110406312327200_CIT0012","doi-asserted-by":"crossref","DOI":"10.7326\/M20-2003","article-title":"Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study [published online May 6, 2020]","author":"Wichmann","year":"2020","journal-title":"Ann Intern Med."},{"key":"2020110406312327200_CIT0013","doi-asserted-by":"crossref","DOI":"10.2139\/ssrn.3572890","volume-title":"Pulmonary post-mortem findings in a large series of COVID-19 cases from Northern Italy","author":"Carsana","year":""},{"key":"2020110406312327200_CIT0014","article-title":"Post-mortem examination of COVID19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings of lungs and other organs suggesting vascular dysfunction [published online May 4, 2020]","author":"Menter","journal-title":"Histopathology."},{"key":"2020110406312327200_CIT0015","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMoa2015432","article-title":"Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19","author":"Ackermann","year":"2020;383-120-128","journal-title":"N Engl J Med."},{"key":"2020110406312327200_CIT0016","doi-asserted-by":"crossref","DOI":"10.1001\/jama.2020.8907","article-title":"Postmortem examination of patients with COVID-19","author":"Schaller","year":"2020;323:2518-2520","journal-title":"JAMA."},{"key":"2020110406312327200_CIT0017","volume-title":"Robbins and Cotran Pathologic Basis of Disease.","author":"Kumar","edition":"9"},{"key":"2020110406312327200_CIT0018","article-title":"Characteristics associated with out-of-hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York City [published online June 19, 2020]","author":"Lai","journal-title":"JAMA Cardiol."},{"key":"2020110406312327200_CIT0019","doi-asserted-by":"crossref","DOI":"10.1093\/eurheartj\/ehaa508","article-title":"COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests","author":"Baldi","year":"2020","journal-title":"Eur Heart J."},{"key":"2020110406312327200_CIT0020","volume-title":"Dail and Hammar\u2019s Pulmonary Pathology: Vol. 1. Nonneoplastic Lung Disease","author":"Tomashefski","year":"2008","edition":"3"},{"key":"2020110406312327200_CIT0021","first-page":"112","article-title":"The pulmonary vascular lesions of the adult respiratory distress syndrome","volume":"112","author":"Tomashefski","year":"1983","journal-title":"Am J Pathol."}],"container-title":["American Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ajcp\/article-pdf\/154\/6\/748\/34126010\/aqaa156.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ajcp\/article-pdf\/154\/6\/748\/34126010\/aqaa156.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,27]],"date-time":"2021-03-27T12:06:04Z","timestamp":1616846764000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajcp\/article\/154\/6\/748\/5900519"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,2]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,9,2]]},"published-print":{"date-parts":[[2020,11,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ajcp\/aqaa156","relation":{},"ISSN":["0002-9173","1943-7722"],"issn-type":[{"value":"0002-9173","type":"print"},{"value":"1943-7722","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,12]]},"published":{"date-parts":[[2020,9,2]]}}}