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Pulmonary Parenchymal Changes in COVID-19 Survivors

  • Diaz, Ashley1
  • Bujnowski, Daniel2
  • McMullen, Phillip3
  • Lysandrou, Maria1
  • Ananthanarayanan, Vijayalakshmi4
  • Husain, Aliya N.3
  • Freeman, Richard5
  • Vigneswaran, Wickii T.5
  • Ferguson, Mark K.6
  • Donington, Jessica S.6
  • Madariaga, Maria Lucia L.6
  • Abdelsattar, Zaid M.5
  • 1 Pritzker School of Medicine, University of Chicago, Chicago, Illinois
  • 2 Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
  • 3 Department of Pathology, University of Chicago Medicine, Chicago, Illinois
  • 4 Department of Pathology, Loyola University Medical Center, Maywood, Illinois
  • 5 Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
  • 6 Section of Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
Published Article
The Annals of thoracic surgery
Publication Date
Jul 31, 2021
DOI: 10.1016/j.athoracsur.2021.06.076
PMID: 34343471
PMCID: PMC8325553
PubMed Central
  • Original Article


Background As the COVID-19 pandemic moves into the survivorship phase, questions regarding long-term lung damage remain unanswered. Previous histopathologic studies are limited to autopsy reports. We studied lung specimens from COVID-19 survivors who underwent elective lung resections to determine whether postacute histopathologic changes are present. Methods This multicenter observational study included 11 adult COVID-19 survivors who had recovered but subsequently underwent unrelated elective lung resection for indeterminate lung nodules or lung cancer. We compared these against an age- and procedure-matched control group who never contracted COVID-19 (n = 5) and an end-stage COVID-19 group (n = 3). A blinded pulmonary pathologist examined the lung parenchyma focusing on 4 compartments: airways, alveoli, interstitium, and vasculature. Results Elective lung resection was performed in 11 COVID-19 survivors with asymptomatic (n = 4), moderate (n = 4), and severe (n = 3) COVID-19 infections at a median 68.5 days (range 24-142 days) after the COVID-19 diagnosis. The most common operation was lobectomy (75%). Histopathologic examination identified no differences between the lung parenchyma of COVID-19 survivors and controls across all compartments examined. Conversely, patients in the end-stage COVID-19 group showed fibrotic diffuse alveolar damage with intra-alveolar macrophages, organizing pneumonia, and focal interstitial emphysema. Conclusions In this study to examine the lung parenchyma of COVID-19 survivors, we did not find distinct postacute histopathologic changes to suggest permanent pulmonary damage. These results are reassuring for COVID-19 survivors who recover and become asymptomatic.

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