Mari Svensson Ann, Hansen Tomas, Nyren Sven, Csatlós Martin, Brunnström Hans
biträdande överläkare, ME radiologi KS Solna, Karolinska universitetssjukhuset.
med dr, överläkare, Bild- och funktionsmedicinskt centrum, Akademiska sjukhuset, Uppsala.
Lakartidningen. 2020 Jun 1;117:20086.
We here describe the current knowledge about the radiologic and histologic pulmonary features of covid-19, caused by SARS-CoV-2, and present lung histology from a case with fatal disease. Initial findings on computed tomography (CT) typically include peripheral multifocal bilateral ground-glass opacities, and correspondingly microscopic alveolar edema. This is followed by peripheral consolidations with air bronchogram and perilobular pattern on CT, signs of organizing pneumonia, corresponding to loose (potentially reversible) fibrosis. The posterior parts of the lungs and the lower lobes are typically more markedly affected. In severe disease with acute respiratory distress syndrome, thickened interlobular septa and crazy paving pattern appear on CT, which corresponds to histologic diffuse alveolar damage with, depending on the stage of the disease, features such as edema, hyaline membranes, reactive epithelium, inflammation, and fibrosis.
我们在此描述了由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的新型冠状病毒肺炎（COVID-19）的放射学和组织学肺部特征的现有知识，并展示了一例致命病例的肺组织学情况。计算机断层扫描（CT）的初始表现通常包括外周多灶性双侧磨玻璃影，相应地，显微镜下可见肺泡水肿。随后，CT上出现外周实变伴空气支气管征和肺小叶周围型，这是机化性肺炎的表现，对应于疏松（可能可逆）的纤维化。肺的后部和下叶通常受影响更明显。在患有急性呼吸窘迫综合征的重症病例中，CT上可见小叶间隔增厚和铺路石征，这对应于组织学上的弥漫性肺泡损伤，根据疾病阶段不同，其特征包括水肿、透明膜、反应性上皮、炎症和纤维化。
