Pulmonary vascular proliferation in patients with severe COVID-19: an autopsy study

Diffuse alveolar damage and thrombi are the most common lung histopathological lesions reported in patients with severe COVID-19. Although some studies have suggested increased pulmonary angiogenesis, the presence of vascular proliferation in COVID-19 lungs has not been well characterised. Glomeruloid-like microscopic foci and/or coalescent vascular proliferations measuring up to 2 cm were present in the lung of 14 out of 16 autopsied patients. These lesions expressed CD31, CD34 and vascular endothelial cadherin. Platelet-derived growth factor receptor-beta immunohistochemistry and dual immunostaining for CD34/smooth muscle actin demonstrated the presence of pericytes. These vascular alterations may contribute to the severe and refractory hypoxaemia that is common in patients with severe COVID-19.

Automated summary

Diffuse alveolar damage and thrombi are the most common lung histopathological lesions in severe COVID-19 patients. While some studies have suggested increased pulmonary angiogenesis, the characteristics of vascular proliferation in COVID-19 lungs have not been fully described. Presence of glomeruloid-like microscopic foci and/or coalescent vascular proliferations in the lungs of 14 out of 16 autopsied patients were observed, which may contribute to severe and refractory hypoxemia seen in severe COVID-19 cases.