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. 2023 Jan 4;102(8):814–825. doi: 10.1038/s41374-022-00783-x

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© 2022 United States & Canadian Academy of Pathology.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Fig. 5 — SARS-CoV-2 infection of the endothelium, resultant damage, and thrombosis as a defining feature in COVID-19-associated cardiac injury.

A large characteristic thrombus (750–100 µm) penetrating an artery within the myocardium of a COVID-19-positive decedent was reported. SARS-CoV-2 spike protein was prominently expressed (brown) in the endothelium. Neutrophil extracellular traps (NETs) were interspersed throughout as indicated by myeloperoxidase (MPO) (brown) within the thrombus and in the artery wall near the endothelial-thrombus interface. Archetypical expression of vWF (brown) indicative of endothelial injury is prominent in the lining of the elastica and along with fibrinogen (brown) forms the thrombus. CD45 (leukocyte common antigen) (brown) demonstrates prominent inflammation within the thrombus and surrounding vasculature. H&E indicates hematoxylin and eosin staining. Images are shown at ×10 magnification, with inserts shown at ×40 magnification.