. 2020 Dec 2;63(7):350–361. doi: 10.11622/smedj.2020174

Table 5.

Autopsy findings in lungs of patients with COVID-19.

Study	n	Findings	Distinctive features
Ackermann et al⁽²¹⁾	7	All specimens showed diffuse alveolar damage, linear intra-alveolar fibrin deposition and Type 2 pneumocyte hyperplasia. 4 out of 7 specimens had pulmonary artery thrombi (similar to matched influenza cohort). 7 out of 7 specimens showed alveolar capillary microthrombi (9 times more prevalent in COVID-19 as compared to influenza cohort: 159 vs. 16 thrombi/cm² of vascular lumen).	Severe endothelial damage with disruption of cell membranes Widespread vascular thrombosis with microangiopathy and alveolar capillaries occlusion Increased angiogenesis of pulmonary vessels

Wichmann et al⁽²⁷⁾	12	8 (67%) out of 12 autopsies revealed diffuse alveolar damage, hyaline membranes thickening, pneumocytes hyperplasia, lymphocytic infiltration of alveolar with inflammatory exudates. 7 (58%) out of 12 cases had DVT. 4 (33%) out of 12 cases had PE.	High incidence of DVT and PE, which were also the cause of death

Menter et al⁽²⁵⁾	21	Histology showed severe capillary congestion with hyaline membranes, reactive pneumocyte changes, diffuse alveolar damage. 4 (19%) out of 21 cases had PE. 5 (45%) out of 11 cases had alveolar capillary microthrombi.	Morphological changes in lung not as severe as SARS or MERS virus Authors postulated that COVID-19 may predispose to pulmonary microangiopathy through additional mechanism on top of direct alveolar endothelial injury

Carsana et al⁽²³⁾	38	There was evidence of diffuse alveolar disease, capillary congestion and Type 2 pneumocytes hyperplasia in all cases. Majority also had hyaline membranes, interstitial inflammatory infiltrates and oedema. 33 (86.8%) out of 38 cases had platelet-fibrin thrombi in small arterial vessels.	Diffuse thrombosis of small pulmonary vessels is frequently present in autopsy findings of COVID-19 cases.

Magro et al⁽²⁴⁾	5	Lung and skin biopsies showed generalised thrombotic microvascular injury.	Extensive deposition of complement components within lung septal microvasculature, suggesting complement pathways as a mechanism of thrombosis

Dolhnikoff et al⁽²²⁾	10	8 (80%) out of 10 cases had fibrinous microthrombi in small pulmonary arterioles.	Frequency of pulmonary micro-thrombosis is high in autopsy findings of COVID-19.

Schaller et al⁽²⁶⁾	12	All cases had evidence of diffuse alveolar damage, hyaline membrane formation, intra-alveolar oedema and thickened alveolar septa with perivascular lymphocyte-plasmocytic infiltration.

COVID-19: coronavirus disease 2019; DVT: deep venous thrombosis; PE: pulmonary embolism; SARS: severe acute respiratory syndrome; MERS: Middle East respiratory syndrome