This paper collates the pathological findings from initial published autopsy reports on 23 patients with coronavirus disease 2019 (COVID-19) from 5 centers in the United States of America, including 3 cases from Houston, Texas. Findings confirm that COVID-19 is a systemic disease with major involvement of the lungs and heart. Acute COVID-19 pneumonia has features of a distinctive acute interstitial pneumonia with a diffuse alveolar damage component, coupled with microvascular involvement with intra- and extravascular fibrin deposition and intravascular trapping of neutrophils, and, frequently, with formation of microthombi in arterioles. Major pulmonary thromboemboli with pulmonary infarcts and/or hemorrhage occurred in 5 of the 23 patients. Two of the Houston cases had interstitial pneumonia with diffuse alveolar damage pattern. One of the Houston cases had multiple bilateral segmental pulmonary thromboemboli with infarcts and hemorrhages coupled with, in nonhemorrhagic areas, a distinctive interstitial lymphocytic pneumonitis with intra-alveolar fibrin deposits and no hyaline membranes, possibly representing a transition form to acute fibrinous and organizing pneumonia. Multifocal acute injury of cardiac myocytes was frequently observed. Lymphocytic myocarditis was reported in 1 case. In addition to major pulmonary pathology, the 3 Houston cases had evidence of lymphocytic pericarditis, multifocal acute injury of cardiomyocytes without inflammatory cellular infiltrates, depletion of splenic white pulp, focal hepatocellular degeneration and rare glomerular capillary thrombosis. Each had evidence of chronic cardiac disease: hypertensive left ventricular hypertrophy (420 g heart), dilated cardiomyopathy (1070 g heart), and hypertrophic cardiomyopathy (670 g heart). All 3 subjects were obese (BMIs of 33.8, 51.65, and 35.2 Kg/m²). Overall, the autopsy findings support the concept that the pathogenesis of severe COVID-19 disease involves direct viral-induced injury of multiple organs, including heart and lungs, coupled with the consequences of a procoagulant state with coagulopathy.

本文整理了来自美国 5 个中心的 23 名 2019 年冠状病毒病 (COVID-19) 患者的初步尸检报告的病理结果，其中 3 例来自德克萨斯州休斯顿。研究结果证实，COVID-19 是一种全身性疾病，主要累及肺和心脏。急性 COVID-19 肺炎具有独特的急性间质性肺炎的特征，具有弥漫性肺泡损伤成分，伴有微血管受累，伴有血管内外纤维蛋白沉积和血管内中性粒细胞滞留，并且经常在小动脉中形成小血栓。23 名患者中有 5 名发生严重肺血栓栓塞并伴有肺梗塞和/或出血。休斯顿的两例病例患有间质性肺炎，伴有弥漫性肺泡损伤。休斯顿的一例病例有多发性双侧节段性肺血栓栓塞，伴有梗死和出血，在非出血区域，伴有独特的间质性淋巴细胞性肺炎，肺泡内有纤维蛋白沉积，无透明膜，可能是向急性纤维蛋白性机化性肺炎的过渡形式。经常观察到心肌细胞的多灶性急性损伤。报告淋巴细胞性心肌炎1例。除了主要的肺部病变外，休斯顿的 3 例病例还存在淋巴细胞性心包炎、无炎性细胞浸润的心肌细胞多灶性急性损伤、脾白髓耗竭、局灶性肝细胞变性和罕见的肾小球毛细血管血栓形成的证据。每个人都有慢性心脏病的证据：高血压左心室肥厚（420克心脏）、扩张型心肌病（1070克心脏）和肥厚性心肌病（670克心脏）。所有 3 名受试者均为肥胖（BMI 分别为 33.8、51.65 和 35.2 Kg/m ²）。总体而言，尸检结果支持这样的观点，即严重的 COVID-19 疾病的发病机制涉及病毒直接引起的多个器官损伤，包括心脏和肺，以及促凝血状态和凝血病的后果。