Conclusions
This study emphasis that diffuse alveolar damage and microvascular
pulmonary thrombosis in SARS-CoV-2 patients is main pathologic finding
of ARDS patients caused by either direct viral cytopathic effect or host
immune and inflammatory reaction. These findings might describe severe
hypoxemia in COVID-19 patients suffering ARDS.
Our data strongly indicates the role of appropriate oxygen support and
anticoagulation therapy with strict monitoring.
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Figure legends
Figure 1. Case 1: Axial CT images show diffuse ground glass opacity with
some crazy paving and consolidation (a,b). A small amount of lungs is
spared. CT severity score is 38/40 according to the system proposed by
Yang R, Li X, Liu H, Zhen Y, Zhang X, Xiong Q, Luo Y, Gao C, Zeng W.
Chest ct severity score: An imaging tool for assessing severe covid-19.
Radiology: Cardiothoracic Imaging. 2020 Mar 30;2(2): e200047.
Figure 2. Case 2: Axial CT images of the lungs show extensive ground
glass appearance in the lungs, mainly in the peripheral regions (a).
Some crazy paving and consolidation is also present in addition to mild
bilateral pleural effusion (b). CT severity score is 24/40 according to
the system proposed by Yang R, Li X, Liu H, Zhen Y, Zhang X, Xiong Q,
Luo Y, Gao C, Zeng W. Chest ct severity score: An imaging tool for
assessing severe covid-19. Radiology: Cardiothoracic Imaging. 2020 Mar
30;2(2):e200047.
Fig 3. Lungs and renal pathologic findings in case 1.
Pathological manifestation of lung tissue, Diffuse alveolar damage in
acute phase (A)
Note hyaline membrane (arrow) (B,C)
Intranuclear inclusion-like structures (D)
Morphologically acute tubular necrosis on renal biopsy showing
attenuation of tubular epithelium (E)
Fig 4. Pathologic findings of lung tissue (a,b) Diffuse alveolar damage
Pathologic findings of liver tissue. Hepatic steatosis (C)