The pandemia of coronavirus disease 2019 (COVID-19) has caused more than 355,000 confirmed deaths worldwide. However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and duration, invasive therapies, and laboratory features. Early disease is characterized by neutrophilic, exudative capillaritis with microthrombosis and high levels of IL-1beta and IL-6. Later stages are associated with diffuse alveolar damage and ongoing intravascular thrombosis in small to medium-sized pulmonary vessels, occasionally with areas of infarction equivalents, accompanied by laboratory features of disseminated intravascular coagulation. In late stages, organizing pneumonia with extensive intra-alveolar proliferation of fibroblasts and marked metaplasia of alveolar epithelium can be observed. Viral RNA is encountered in the lung, with virus particles in endothelial cells and pneumocytes. In many patients, multi-organ failure with severe liver damage sets in finally, possibly as consequence of an early-onset pro-inflammatory cytokine storm and/or thrombotic microangiopathy.

2019年冠状病毒病大流行（COVID-19）已导致全球355,000多例确诊死亡。但是，关于验尸结果的出版物很少。我们介绍了4例致命COVID-19的肺部表现，其一系列肺部病理反应反映了病程和病程，侵袭性疗法和实验室特征。早期疾病的特征是嗜中性，渗出性毛细血管炎，伴有微血栓形成和高水平的IL-1β和IL-6。后期与弥散性肺泡损害和中小尺寸肺血管中持续的血管内血栓形成有关，偶尔有梗死面积相等，并伴有弥散性血管内凝血的实验室特征。在后期，可以观察到组织性肺炎伴有成纤维细胞在肺泡内的广泛增殖和肺泡上皮的明显化生。肺部会遇到病毒RNA，内皮细胞和肺细胞中会带有病毒颗粒。在许多患者中，最终会出现严重肝损害的多器官衰竭，这可能是由于早发的促炎性细胞因子风暴和/或血栓形成性微血管病的结果。