Table 1.

Table enlisting various studies on COVID19, highlighting the radiological and pathological aspects of the disease in multiple systems of the body.

Authors, Country	Aim of study	No. of cases studied	Clinical features & Radiological details	Biomarkers & Haematological findings	Histopathology & Cytomorphology	IHC/Immuno-floroscence	Electron microscopy
Zhang H et al, China	Histo-pathological findings and IHC in COVID19 infected lung	01	C/F: 72-year-old diabetic & hypertensive presented with fever & cough.	–	DAD, intra-alveolar fibrinous exudates & loose interstitial fibrosis.	Rp3 NP protein of SARS–CoV-2: prominent expression on alveolar epithelial cells & on damaged desquamated cells within alveolar space.	–
			CT scan: Patchy ground glass–like opacifications with pleural thickening and mediastinal lymphadenopathy.
Copin MC et al, France	Histological patterns of lung injury	06	–	–	-01 case: Lymphocytic viral pneumonia	–	–
					-05 cases: AFOP with intra-alveolar “fibrin balls”
Xu Z et al, China	Pathological findings of COVID-19 associated with acute respiratory distress syndrome	01	Chest X-ray: Multiple patchy shadows in B/L lungs	Peripheral blood flow cytometry:	LUNGS: -B/L DAD, cellular fibro-myxoid exudate.	–	–
				- Reduced CD4 & CD8 T cells	-Viral cytopathic effect: multinucleated syncytial cells with atypical enlarged pneumocytes in intra-alveolar spaces.
				- High proportions of HLA-DR (CD4 3·47 %) & CD38 (CD8 39·4%) double-positive fractions	HEART: -Interstitial mononuclear inflammatory infiltrates
				- Increased concentration of highly proinflammatory CCR6+ Th17 in CD4 T cells	LIVER: -Moderate microvesicular steatosis with mild lobular & portal activity
Fox SE et al, USA	Autopsy series studying pulmonary and cardiac Pathology in Covid19.	04	C/F: Aged 44−78 years with hypertension -Mild cough & fever with sudden respiratory decompensation	-Elevated ferritin & fibrinogen levels	-LUNGS: (04 cases) -Bilateral DAD, mild-to-moderate lymphocytic infiltrate, megakaryocytes within small vessels & alveolar capillaries.	–	–
				-Increased AST	-Viral cytopathic effect: cytomegaly enlarged nuclei & bright, eosinophilic nucleoli within alveolar spaces.
				-Increased d-dimer levels in all patients near death.	HEART: (04 cases) -Scattered individual cell myocyte necrosis.
Schaller T et al, Germany	Postmortem Examination of Patients With COVID-19	10	C/F: Fever, cough & dyspnea.	–	LUNGS: (10 cases) -Disseminated DAD at different stages more pronounced in middle & lower lobes.	–	–
			X ray: (09 cases) ground-glass opacity predominantly in middle & lower lung fields.		-Fully established fibrosis in 01 case.
					-Minor neutrophilic infiltration in 5 cases
					HEART: -Mild lymphocytic myocarditis (04 cases) & epicarditis (02 cases)
					LIVER: -Non-specific Periportal liver lymphocyte infiltration & fibrosis
					BRAIN: -No change
Giani M et al, Italy	BAL fluid analysis	01	C/F: Fatigue & fever progressing to respiratory distress & hypoxia	–	CYTOMORPHOLOGY:	–	–
					-Fibrino-hematic material with scattered alveolar macrophages & predominance of activated plasma cells (CD138+), admixed with T & scattered B lymphocytes.
					-Alveolar macrophages: showed nuclear clearing or intranuclear cytopathic inclusions
Zhang Y et al, China	Assess liver impairment in COVID19 patients	115	C/F: Respiratory distress	Elevated levels of:	LIVER: (01 case) -Non-specific findings.	–	–
				-ALT: 11/115	-Mild sinusoidal dilatation with minimal lymphocytic infiltration
				-AST: 17/115
				-S.biliubin: 08/115 cases.
Tian S et al, China	Pathological assessment of postmortem core biopsies,	04	C/F: Aged 59−81 years with each patient having at least one underlying disease, including immunocompromised status.	Case 1: -elevated pro-BNP & hypertensive cardiac troponin (d/t history of previous MI)	LUNGS:	–	–
			CT scan (03 cases): Multiple patchy ground glass opacities		- DAD (in all 04 cases)
			X ray (01 case): Patchy high-density shadows with worsening in subsequent days.	All 04 cases:	- Case no. 02: also showed pneumocyte injury with focal sloughing & formation of syncytial giant cells
				-Normal AST/ALT/S.bilirubin levels	-Case no. 04: also showed fibrinoid necrosis in small vessels with abundant intra-alveolar neutrophilic infiltration, consistent with bronchopneumonia due to superimposed bacterial infection.
					LIVER:
					-Case 1: sinusoidal dilatation, nuclear glycogen in hepatocytes, focal macrovesicular steatosis and features of CLL
					-Case 2: cirrhosis consistent with his history & mild zone 3 sinusoidal dilatation
					-Case 3&4: mild lobular lymphocytic infiltration.
					HEART: -Non-specific findings with no epicardial/myocardial inflammation.
Su H et al, China.	Histopathological analysis of kidney biopsy in 26 postmortem cases.	26	C/F: 26 cases died of respiratory failure due to COVID19	- Leukocytois in 10 cases.	-Prominent ATI -Loss of brush border, vacuolar degeneration & dilatation of tubular lumen with cellular debris in almost all cases,	DIF:Nonspecific IgM & C3 trapping in glomeruli.	Coronavirus-like particles:
					−2 cases: multiple foci of bacteria & diffuse polymorphonuclear casts in tubular lumen.	Indirect IF: Positive granular nuclear and cytoplasmic staining with SARS-CoV nucleoprotein in tubular epithelium (in 03 out of 06 cases)	65−136 nm, with distinctive spikes, 20 −25 nm in cytoplasm of renal proximal tubular epithelium/podocytes /less so in distal tubules.
					−3 cases: pigmented casts with high levels of CPK possibly due to rhabdomyolysis
					−5 cases:Endothelial cell swelling with variable foamy degeneration in old/hypertensive/diabetic cases.
					−3 cases: segmental fibrin thrombus in glomerular capillary loops with severe injury of the endothelium Occasional podocyte vacuolation & detachment from the glomerular basement membrane.
Christopher P. Larsen et al, USA	Collapsing Glomerulopathy in a Patient With COVID-19	01	C/F: 63-year-old hypertensive male with fatigue, high-grade fever (39.7	-Elevated CRP & D-dimer	Kidney Biopsy: −14 glomeruli were globally sclerotic. Many of the intact glomeruli showed tuft collapse with overlying epithelial hypertrophy & hyperplasia in the Bowman space.	DIF: Negative for IgA, IgG, IgM, C3, C1q, kappa & lambda in Glomeruli.	No definitive viral particles
				-Lymphopenia	-Tubular epithelium injury: most prominent in the PCT
					-Interstitial fibrosis, tubular atrophy, inflammatory infiltrate in interstitium consisting of lymphocytes, plasma cells with few scattered eosinophils
Buja LM et al, USA	Emerging spectrum of cardiopulmonary pathology of COVID-19:	03	C/F: Autopsy done on: Case 1: 62-year-old obese male history of respiratory illness died of COVID19 Case 2: 34-year-old obese, diabetic hypertensive with headache, shortness of breath & productive cough died of COVID19 Case 3: 48-year-old obese died of COVID19	–	LUNGS:	–	Case 1:
			CT scan: (Case 2) B/L upper & lower lobe ground-glass with early consolidative alveolar opacities of rounded morphology.		-Case 1: early DAD with multiple hyaline membranes & focal mild inflammation with lymphocytes & macrophages in some alveolar spaces.		-Strands of precipitated fibrin & entrapped neutrophils within alveolar capillaries -Larger deposits of fibrin in alveolar spaces.
					-Case 2:interstitial lymphocytic pneumonitis with lymphocytic infiltrates around small blood vessels & terminal bronchioles. Microthrombi in some pulmonary arterioles.		-No Viral particles in heart or lungs.
					-Case 3: right pleura showed empyema. Right lung showed evidence of atelectasis & DAD. DAD was more pronounced in the expanded left lung.
					LIVER:
					-Case 1 & 2: Moderate macrovesicular steatosis
					-Case 3: Moderate macrovesicular steatosis, lympho-plasmacytic triaditis with portal fibrosis and early portal-portal bridging fibrosis.
					HEART:
					-Case 1: Cardiomyocytes with moderately enlarged hyperchromatic nuclei with vacuolar degenerative change. No myocarditis.
					-Case 2: Individual damaged cardiomyocytes
					-Case 3: Multifocal lymphocytic infiltrates in epicardium. Myocytes: enlarged hyperchromatic nuclei, changes of acute injury.
					KIDNEY: -Case 1: Hyaline arteriolosclerosis with glomerulosclerosis
					-Case 2: Occasional fibrin-platelet thrombus in renal glomerular capillaries.
					-Case 3: Mild hyaline arteriolosclerosis, periglomerular hyaline arteriolosclerosis with rare holo-sclerotic glomeruli.
Tavazzi G et al, Italy	Myocardial localization of coronavirus in COVID‐19 cardiogenic shock	01	C/F: 69-year-old patient with flu-like symptoms rapidly degenerating into respiratory distress, hypotension & shock.	-Lymphopenia	HEART: -Cardiac myocytes showed non‐specific features consisting of focal myofibrillar lysis, and lipid droplets.	Immune‐light microscopy: Large (>20 μm), vacuolated, CD68‐positive macrophages	Single / small groups of viral particles with electron‐dense spike‐like structures & size between 70–120 nm within the interstitial cells of myocardium.
				-Raised CRP
				- Increased hs‐TnI
Varga Z et al, Switzerland.	Endothelial cell infection and endotheliitis in COVID-19	03	C/F: Autopsies done on: Hypertensive males with COVID19 disease developing multi-organ failure	–	-Case 1: Inflammatory cells associated with endothelium & apoptotic bodies in heart, small bowel & lungs	–	Case 1: In transplanted kidney- Viral inclusion structures (dense circular surface with lucid centre) in endothelial cells
					-Case 2: Lymphocytic endotheliitis in lung, heart, kidney, and liver with liver cell necrosis. No lymphocytic myocarditis.
					-Case 3: Small intestine resection showed prominent endotheliitis of the submucosal vessels with apoptotic bodies
Von Weyhern C.H., et al, Germany	Early evidence of pronounced brain involvement in fatal COVID-19	06	C/F: Autopsies of 06 case aged 58−82 years who died from COVID-19	-Elevated CRP & IL-6 in all the cases	BRAIN:	–	–
				-Leukocytosis in 2 cases	All cases:-Lymphocytic pan-encephalitis & meningitis
					-Patients with age <65yrs: Death due to Petechial bleeding and intracranial hemmorhage.
					LUNGS:
					−05 cases: DOD
					=01 case: Organizing Pneumonia Pattern
Solomon IH et al, England	Neuropathological Features of Covid-19	18	C/F: Myalgia headache & decreased taste	–	-All cases:Acute hypoxic injury in cerebrum & cerebellum with loss of neurons in the cerebral cortex, hippocampus & cerebellar Purkinje cell layer. No thrombi/vasculitis.	IHC to detect SARS-CoV:	–
						Negative in neurons, glia, endothelium& immune cells.
					−02 cases: perivascular lymphocytes
					−01 case: focal leptomeningeal inflammation
Reichard RR et al, USA	A spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology	01	C/F: 71-year-old male with fatigue and exertional dyspnea,	Elevated CRP, IL-6 & ferritin levels	-Perivascular acute disseminated encephalomyelitis (ADEM)-like pathology: Foci of intraparenchymal blood that disrupted the white matter, with macrophages at periphery of the lesions	–	–
			CT Chest: Parenchymal consolidation and surrounding ground-glass opacities following a peri-broncho vascular distribution.		- Luxol fast blue: loss of myelin,
Poyiadji N et al, USA	COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy	01	C/F: 58-year-old female with 3-day history of cough, fever & altered mental status.	–	–		–
			NC-CT head: Symmetric hypoattenuation within the bilateral medial thalami.
			MRI: Haemorrhagic rim enhancing lesions within the bilateral thalami, medial temporal lobes & subinsular regions
Galvan et al, Spain	Classification of the cutaneous manifestations of COVID ‐19	375	C/F:	–	–	–	–
			-Pseudo-chilbain: 71cases
			-Vesicular: 34
			-Urticarial: 73
			-Maculo-papular: 176
			-Livedo/ necrosis: 21
Recalcati et al, Spain	Cutaneous manifestations in COVID‐19: a first perspective	18	C/F:	–	–	–	–
		out of 88 cases -Skin lesions	-Erythematous rash: 14
			-Urticaria: 03 -Chickenpox‐like vesicles :01 case
Marzano AV, Italy	Varicella-like exanthem as a specific COVID-19–associated skin manifestation	22	C/F: Fever, cough headache, weakness, coryza dyspnea, hyposmia, hypogeusia, pharyngodynia, myalgia with skin lesions	–	-Varicella-like papulovesicular exanthem showing:Basket-wave hyperkeratosis,slightly atrophic epidermis, vacuolar degeneration of the basal layer with multinucleate, hyperchromatic keratinocytes & dyskeratotic cells	–	–
Gianotti R et al, Italy	Clinical & histopathological study of skin dermatoses in patients with COVID-19	05	C/F: Fever, sore throat & cough with development of skin lesions during hospital stay.	–	−02 cases: Grover & Kaposi’s varicelliform eruption- dyskeratotic cells, ballooning multinucleated cells, sparse necrotic keratinocytes with lymphocytic satellitosis.	–	–
					−3rd case:Perivascular spongiotic dermatitis with exocytosis with a large nest of Langerhans cells, dense perivascular lymphocytic infiltration with eosinophils around the swollen blood vessels.
					−4th case: Papular erythematous exanthema -edematous dermis with abundant eosinophils & lymphocytic vasculitis
					−5th case: severe maular haemorrhagic rash d/t fintravascular microthrombi within the small dermal vessels
Xiao F et al, China	Evidence for Gastrointestinal Infection of SARS-CoV-2	73	C/F: 73-year-old hospitalized patients infected with COVID19	–	Endoscopic biopsy: (01 case): -Lympho-plasmacytic infiltration along with interstitial edema in the lamina propria of stomach, duodenum, & rectum	-ACE2: Rarely expressed on esophageal epithelium -abundantly distributed on cilia of glandular epithelia.	–
					-Occasional lymphocytes in esophageal squamous epithelium	-Viral nucleocapsid protein: cytoplasm of gastric, duodenal & rectum glandular epithelial cell, but not in esophageal epithelium.
Carvalho A et al, USA	Gastrointestinal Infection Causing Hemorrhagic Colitis in COVID 19	01	C/F: 71-year-old hypertensive female with nausea, vomiting, anorexia, diffuse abdominal pain & distention	Leukocytosis with neutrophilia	Edema in lamina propria with intact crypts with no colitis/ischemia/ or inflammatory bowel disease.	–	–
			CE-CT abdomen: Severe colonic inflammation, most pronounced in ascending, transverse & descending colon
Yang M et al, China	Pathological Findings in the Testes of COVID-19	12	C/F: Postmortem examination of the testes from 12 COVID-19 patients	–	-Sertoli cells showed swelling, vacuolation & cytoplasmic rarefaction, detachment from tubular basement membranes, loss and sloughing into lumens of the intratubular cell mass seen in all cases	ACE2:	No viral particles in all 03 cases tested
					-Classified injury to seminiferous tubules (ST) as:	-Diffuse expression on Sertoli cells.
					Mild – 02 cases	-Strongly expressed on Leydig cells.
					Moderate – 05	-No expression on spermatogonia.
					Severe - 04
Brancatella A et al, Italy	Subacute Thyroiditis After Sars-COV-2 Infection	01	C/F: 8-year-old female with fever, neck pain radiating to the jaw & palpitations	-Elevated free thyroxine & free triiodothyronine levels	–	–	–
			USG neck: Bilateral and diffuse hypoechoic areas	-High inflammatory markers
				-Leukocytosis on peripheral smear
Wei L et al, China	Pathology of the thyroid in severe acute respiratory syndrome	05	C/F: 05 autopsy cases who initially presented with fever and shortness of breath	Lymphopenia on peripheral smear	All cases:	Apoptosis with TUNEL assay: apoptosis was observed in both the follicular epithelium and the interfollicular region of all patients with SARS	–
					-Destruction of the follicular epithelium and exfoliation of epithelial cells into the follicle.
					-Follicles: dilated/ collapsed/distorted with an irregular outline/ microfollicle configuration.
					−01 case: congested with severe damage in follicular epithelium.

KEY:

DAD - Diffuse alveolar damage.

AFOP -Acute fibrinous and organizing pneumonia.

B/L - bilateral.

AKI - Acute Kidney injury.

C/F - clinical features.

CRP - C-reactive protein.

IL-6 - Interleukin 6.

hs‐TnI - Troponin I.