{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T23:15:29Z","timestamp":1782170129558,"version":"3.54.5"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,7,24]],"date-time":"2020-07-24T00:00:00Z","timestamp":1595548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2013\/17159\u20102"],"award-info":[{"award-number":["2013\/17159\u20102"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV\u2010002396"],"award-info":[{"award-number":["INV\u2010002396"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Brazil ranks high in the number of coronavirus disease 19 (COVID\u201019) cases and the COVID\u201019 mortality rate. In this context, autopsies are important to confirm the disease, determine associated conditions, and study the pathophysiology of this novel disease. The aim of this study was to assess the systemic involvement of COVID\u201019. In order to follow biosafety recommendations, we used ultrasound\u2010guided minimally invasive autopsy (MIA\u2010US), and we present the results of 10 initial autopsies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>We used MIA\u2010US for tissue sampling of the lungs, liver, heart, kidneys, spleen, brain, skin, skeletal muscle and testis for histology, and reverse transcription polymerase chain reaction to detect severe acute respiratory syndrome coronavirus 2 RNA. All patients showed exudative\/proliferative diffuse alveolar damage. There were intense pleomorphic cytopathic effects on the respiratory epithelium, including airway and alveolar cells. Fibrinous thrombi in alveolar arterioles were present in eight patients, and all patients showed a high density of alveolar megakaryocytes. Small thrombi were less frequently observed in the glomeruli, spleen, heart, dermis, testis, and liver sinusoids. The main systemic findings were associated with comorbidities, age, and sepsis, in addition to possible tissue damage due to the viral infection, such as myositis, dermatitis, myocarditis, and orchitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MIA\u2010US is safe and effective for the study of severe COVID\u201019. Our findings show that COVID\u201019 is a systemic disease causing major events in the lungs and with involvement of various organs and tissues. Pulmonary changes result from severe epithelial injury and microthrombotic vascular phenomena. These findings indicate that both epithelial and vascular injury should be addressed in therapeutic approaches.<\/jats:p><\/jats:sec>","DOI":"10.1111\/his.14160","type":"journal-article","created":{"date-parts":[[2020,5,22]],"date-time":"2020-05-22T21:22:09Z","timestamp":1590182529000},"page":"186-197","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":267,"title":["Pulmonary and systemic involvement in COVID\u201019 patients assessed with ultrasound\u2010guided minimally invasive autopsy"],"prefix":"10.1111","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6659-7186","authenticated-orcid":false,"given":"Amaro N","family":"Duarte\u2010Neto","sequence":"first","affiliation":[{"name":"BIAS\u2014Brazilian Image Autopsy Study Group Departamento de Patologia Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata A A","family":"Monteiro","sequence":"additional","affiliation":[{"name":"BIAS\u2014Brazilian Image Autopsy Study Group Departamento de Patologia Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz F F","family":"da Silva","sequence":"additional","affiliation":[{"name":"BIAS\u2014Brazilian Image Autopsy Study Group Departamento de Patologia Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Servi\u00e7o de Verifica\u00e7\u00e3o de \u00d3bitos da Capital Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise M A C","family":"Malheiros","sequence":"additional","affiliation":[{"name":"BIAS\u2014Brazilian Image Autopsy Study Group Departamento de Patologia Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen P","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Departamento de Cardiopneumologia Instituto do Cora\u00e7\u00e3o S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jair","family":"Theodoro\u2010Filho","sequence":"additional","affiliation":[{"name":"BIAS\u2014Brazilian Image Autopsy Study Group Departamento de Patologia Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o R R","family":"Pinho","sequence":"additional","affiliation":[{"name":"Departamento de Gastroenterologia LIM\u201007 S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele S","family":"Gomes\u2010Gouv\u00eaa","sequence":"additional","affiliation":[{"name":"Departamento de Gastroenterologia LIM\u201007 S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana P M","family":"Salles","sequence":"additional","affiliation":[{"name":"Departamento de Gastroenterologia LIM\u201007 S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilka R S","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Departamento de Radiologia e Oncologia Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thais","family":"Mauad","sequence":"additional","affiliation":[{"name":"BIAS\u2014Brazilian Image Autopsy Study Group Departamento de Patologia Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo H N","family":"Saldiva","sequence":"additional","affiliation":[{"name":"BIAS\u2014Brazilian Image Autopsy Study Group Departamento de Patologia Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9073-9989","authenticated-orcid":false,"given":"Marisa","family":"Dolhnikoff","sequence":"additional","affiliation":[{"name":"BIAS\u2014Brazilian Image Autopsy Study Group Departamento de Patologia Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,24]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"World Health Organization.Coronavirus disease 2019 (COVID\u201019) situation Report\u2014101. Available at:https:\/\/www.who.int\/docs\/default\u2010source\/coronaviruse\/situation\u2010reports\/20200430\u2010sitrep\u2010101\u2010covid\u201019.pdf?sfvrsn=2ba4e093_2(accessed 1 May 2020)."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30566-3"},{"key":"e_1_2_8_4_1","unstructured":"Minist\u00e9rio da Sa\u00fade\u2010Secretaria de Vigil\u00e2ncia em Sa\u00fade.Boletim Epidemiol\u00f3gico Especial\u201414|SE 18\u201426 de abril de 2020. Available at:https:\/\/portalarquivos.saude.gov.br\/images\/pdf\/2020\/April\/27\/2020\u201004\u201027\u201018\u201005h\u2010BEE14\u2010Boletim\u2010do\u2010COE.pdf(accessed 29 April 2020)."},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa415"},{"key":"e_1_2_8_6_1","first-page":"1843","article-title":"Detection of SARS\u2010CoV\u20102 in different types of clinical specimens","volume":"323","author":"Wang W","year":"2020","journal-title":"JAMA"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30076-X"},{"key":"e_1_2_8_8_1","first-page":"411","article-title":"A pathological report of three COVID\u201019 cases by minimally invasive autopsies","volume":"49","author":"Yao XH","year":"2020","journal-title":"Zhonghua Bing Li Xue Za Zhi."},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-0533"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30937-5"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-020-0536-x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqaa062"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2020.02.010"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30243-5"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2020-206522"},{"key":"e_1_2_8_16_1","unstructured":"Centers for Disease Control and Prevention\u2014Coronavirus Disease 2019 (COVID\u201019).Collection and submission of postmortem specimens from deceased persons with known or suspected COVID\u201019 March 2020 (Interim Guidance). Available at:https:\/\/www.cdc.gov\/coronavirus\/2019\u2010ncov\/hcp\/guidance\u2010postmortem\u2010specimens.html#(accessed 6 April 2020)."},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0007625"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-002-0607-z"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0219291"},{"key":"e_1_2_8_20_1","unstructured":"Centers for Disease Control and Prevention\u2014Coronavirus Disease 2019 (COVID\u201019).Interim guidelines for collecting handling and testing clinical specimens from persons for coronavirus disease 2019 (COVID\u201019). Available at:https:\/\/www.cdc.gov\/coronavirus\/2019\u2010ncov\/lab\/guidelines\u2010clinical\u2010specimens.html(accessed 6 April 2020)."},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2020.25.3.2000045"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.00271-13"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiv499"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200909-1420OC"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.01281-09"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.virusres.2007.03.013"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1091\/mbc.E10-04-0338"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14844"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14817"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14781"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004386"},{"key":"e_1_2_8_32_1","first-page":"E006","article-title":"Clinical and coagulation characteristics of 7 patients with critical COVID\u20102019 pneumonia and acro\u2010ischemia","volume":"41","author":"Zhang Y","year":"2020","journal-title":"Zhonghua Xue Ye Xue Za Zhi"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12842"},{"key":"e_1_2_8_34_1","doi-asserted-by":"crossref","unstructured":"LucasSB.The autopsy pathology of sepsis\u2010related death 2012. Available at:http:\/\/www.intechopen.com\/books\/severe\u2010sepsis\u2010and\u2010septic\u2010shock\u2010understanding\u2010a\u2010serious\u2010killer\/the\u2010autopsy\u2010pathology\u2010of\u2010sepsis\u2010and\u2010septic\u2010shock(accessed 29 April 2020).","DOI":"10.5772\/30095"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1095\/biolreprod.105.044776"},{"key":"e_1_2_8_36_1","article-title":"Cardiac involvement in a patient with coronavirus disease 2019 (COVID\u201019)","author":"Inciardi RM","year":"2019","journal-title":"JAMA Cardiol."}],"container-title":["Histopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fhis.14160","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.14160","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/his.14160","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.14160","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T09:47:25Z","timestamp":1693820845000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/his.14160"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,24]]},"references-count":35,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1111\/his.14160"],"URL":"https:\/\/doi.org\/10.1111\/his.14160","archive":["Portico"],"relation":{},"ISSN":["0309-0167","1365-2559"],"issn-type":[{"value":"0309-0167","type":"print"},{"value":"1365-2559","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,24]]},"assertion":[{"value":"2020-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}