Exploring Histomorphological Changes in Lungs Induced by Severe COVID-19: A Comparative study using CT Scan and Lung Ultrasound Assessment
Keywords:
Histomorphological Changes, Lungs, Ground Glass Opacity, Diffuse Alveolar DamageAbstract
Background: Individuals with COVID-19 may experience respiratory collapse due to severe bilateral pneumonia. Because there was a substantial threat of infections during biopsies, histological samples are rare. Objective: The present study aimed to assess the histomorphological alterations in the lungs affected by COVID-19 using a CT scan and lung ultrasonography. Methodology: We conducted a prospective observational study on individuals who had severe COVID-19. Twelve exploration zones were created from the thorax to link lung ultrasonography (LU) and CT-scan findings. Each block was split into 7 cuts of 2.5μm thick sections. Specimens for Histology were stained with Weigert-Van-Giesson (to evaluate elastic fiber architecture) and Masson's trichrome eosine and hematoxylin, (for collagen deposition and fibrosis). SPSS 20 was used for the analysis of the data. Results: The patients' mean age was 61.65 ± 12.57 years, with 96% of them being male. A total of 179 thoracic areas were examined in 25 individuals who underwent evaluation using both thoracic LU and chest CT scans. B2-lines were the most common LU finding (49.7%). Ground-glass opacity (GGO), was the most common CT-scan result (31.3%). Findings from a pathological CT scan were frequently seen when B2-lines or C-lines were found using LU (positive predictive value, PPV, 85.1%). Diffuse alveolar damage (DAD) accounted for 75% of the histological samples, while persistent interstitial inflammation (25%). Conclusion: Lung Ultrasonography (LU) frequently reveals B2-lines and C-profiles in patients experiencing severe COVID-19 and respiratory impairment. These findings often correspond to various CT patterns and histological outcomes such as Diffuse Alveolar Damage (DAD) and lung fibrosis. LU holds potential in predicting prognosis, assessing response to therapy, and optimizing the necessity for CT scans.References
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. DOI: 10.1016/S0140-6736(20)30183-5
WHO Coronavirus Disease (COVID-19) Dashboard. Available from URL: https://covid19.who.int/.
Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S, et al. The role of chest imaging in patient management during the covid-19 pandemic: a multinational consensus statement from the fleischner society. Radiol. 2020;296:172–80.
Blaivas M. Lung ultrasound in evaluation of pneumonia. J Ultrasound Med. 2012;31:823–6. DOI: 10.7863/jum.2012.31.6.823.
Soldati G, Demi M, Inchingolo R, Smargiassi A, Demi L. On the physical basis of pulmonary sonographic interstitial syndrome. J Ultrasound Med. 2016; 35:2075–86.
Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 novel Coronavirus (2019-nCoV) pneumonia. Radiology. 2020; 295:210–7.
Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes on chest CT during recovery from 2019 novel Coronavirus (COVID-19) pneumonia. Radiology. 2020; 13:200370.
Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT Findings in Coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiol. 2020;20:200463.
Trias-Sabrià P, Dorca Duch E, Molina-Molina M, Aso S, DÃez-Ferrer M, MarÃn Muñiz A, Bordas-MartÃnez J, Sabater J, Luburich P, Del Rio B, Solanich X. Radio-Histological Correlation of Lung Features in Severe COVID-19 Through CT-Scan and Lung Ultrasound Evaluation. Front Med. 2022;9:820661.
Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015; 147:1659–70.
Bouhemad B, Mongodi S, Via G, Rouquette I. Ultrasound for “lung monitoring†of ventilated patients. Anesth. 2015; 122:437–47.
Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesth. 2004; 100:9–15.
Moore S, Gardiner E. Point of care and intensive care lung ultrasound: a reference guide for practitioners during COVID-19. Rad. 2020; 26:e297–302.
Soldati G, Smargiassi A, Inchingolo R, Buonsenso D, Perrone T, Briganti DF, et al. Proposal for international standardization of the use of lung ultrasound for COVID-19 patients; a simple, quantitative, reproducible method. J Ultrasound Med. 2020; 39:1413–9.
Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008; 29:16.
Sapino A, Facchetti F, Bonoldi E, Gianatti A, Barbareschi M. Società Italiana di Anatomia Patologica e Citologia - SIAPEC. The autopsy debate during the COVID-19 emergency: the Italian experience. Virchows Arch. 2020; 29:1–3.
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8:420–2.
Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY. Pulmonary pathology of early-phase 2019 novel Coronavirus (COVID-19) pneumonia in two patients with lung cancer. J Thorac Oncol. 2020;15:700–4.
Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. J Clin Pathol. 2020;73:239–42.
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020;104:246–51.
Yin W, Zou T, Qin Y, Yang J, Li Y, Zeng X, et al. Poor lung ultrasound score in shock patients admitted to the ICU is associated with worse outcome. BMC Pulm Med. 2019;19:1.
Soldati G, Demi M, Smargiassi A, Inchingolo R, Demi L. The role of ultrasound lung artifacts in the diagnosis of respiratory diseases. Expert Rev Respir Med. 2019;13:163–72.
Singh AK, Mayo PH, Koenig S, Talwar A, Narasimhan M. The use of M-mode ultrasonography to differentiate the causes of b lines. Chest. 2018; 153:689–96.
Buonsenso D, Piano A, Raffaelli F, Bonadia N, de Gaetano Donati K, Franceschi F. Point-of-care lung ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak. Eur Rev Med Pharmacol Sci. 2020; 24:2776–80.
Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure the BLUE protocol. Chest. 2008; 134:117–25.
Jackson K, Butler R, Aujayeb A. Lung ultrasound in the COVID-19 pandemic. Postgrad Med J. 2021; 97:34–9.
Huang Y, Wang S, Liu Y, Zhang Y, Zheng C, Zheng Y, et al. A preliminary study on the ultrasonic manifestations of peripulmonary lesions of non-critical novel Coronavirus pneumonia (COVID-19). SSRN Electron J. 2020; 97:34–9.
Trias-Sabrià P, Molina-Molina M, Aso S, Argudo MH, Diez-Ferrer M, Sabater J, et al. Lung ultrasound score to predict outcomes in COVID-19. Respir Care. 2021; 66:1263–70.
Yang Y, Huang Y, Gao F, Yuan L, Wang Z. Lung ultrasonography versus chest CT in COVID-19 pneumonia: a two-centered retrospective comparison study from China. Intensive Care Med. 2020; 46:1761–3.
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