School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Histopathology, Beaumont Hospital, Dublin, Ireland.
Ir J Med Sci. 2022 Aug;191(4):1777-1783. doi: 10.1007/s11845-021-02735-8. Epub 2021 Sep 5.
Coronavirus disease 2019 (COVID-19) has claimed the lives of millions of people globally.
This study aims to identify the pathological findings at autopsy of asymptomatic COVID-19 death, to compare the incidence of acute bilateral pulmonary thromboembolism (ABPTE) in asymptomatic COVID-19 deaths versus non-COVID-19 deaths and to explore the possible pathogenesis of thrombosis in COVID-19. We also consider the place of COVID-19 in the death certification of 4 cases who died from ABPTE.
This study primarily reviewed post-mortem reports of 6 asymptomatic COVID-19 deaths. Post-mortem reports for the years 2019 and 2020 were also reviewed to establish the incidence of ABPTE. Each post-mortem report was reviewed for gross examination, histology and toxicology findings. A literature review on COVID-19 autopsy findings, COVID-19 pathogenesis, thrombosis in COVID-19 and asymptomatic SARS-CoV-2 infection was also conducted using PubMed.
Of the 6 asymptomatic COVID-19 deaths, 4 died as a result of ABPTE, 1 died of ischaemic and hypertensive cardiac disease caused by coronary artery disease and ventricular hypertrophy and the remaining case died of heart failure due to dilated cardiomyopathy caused by subendocardial fibrosis. There were 2 cases of bilateral pulmonary thromboembolism (BPTE) in 2019 out of 140 post-mortems. Excluding the 4 cases of ABPTE described already, there was 1 case of ABPTE in 2020 out of 156 post-mortems. A literature review on the pathogenesis of thrombosis in COVID-19 highlighted the significant role that the endothelium plays.
Massive pulmonary thromboembolism may be a significant cause of death in asymptomatic COVID-19 infection.
2019 年冠状病毒病（COVID-19）已在全球夺走数百万人的生命。
本研究旨在确定无症状 COVID-19 死亡患者的尸检病理发现，比较无症状 COVID-19 死亡与非 COVID-19 死亡患者急性双侧肺血栓栓塞症（ABPTE）的发生率，并探讨 COVID-19 中血栓形成的可能发病机制。我们还考虑了 COVID-19 在因 ABPTE 而死亡的 4 例患者的死亡证明中的地位。
本研究主要回顾了 6 例无症状 COVID-19 死亡患者的尸检报告。还回顾了 2019 年和 2020 年的尸检报告，以确定 ABPTE 的发生率。对每份尸检报告进行了大体检查、组织学和毒理学检查。还使用 PubMed 对 COVID-19 尸检发现、COVID-19 发病机制、COVID-19 中的血栓形成和无症状 SARS-CoV-2 感染的文献进行了综述。
在 6 例无症状 COVID-19 死亡患者中，4 例死于 ABPTE，1 例死于由冠状动脉疾病和心室肥大引起的缺血性和高血压性心脏病，其余 1 例死于由心内膜下纤维化引起的扩张型心肌病导致的心衰。在 140 例尸检中，2019 年有 2 例双侧肺血栓栓塞症（BPTE）。不包括已经描述的 4 例 ABPTE 病例，2020 年 156 例尸检中有 1 例 ABPTE。对 COVID-19 中血栓形成发病机制的文献综述强调了内皮在其中的重要作用。
大量肺血栓栓塞症可能是无症状 COVID-19 感染死亡的重要原因。
