Early Phase of Lung Pathology in COVID-19: Case Studies From China
Posted: Tuesday, May 12, 2020
A pair of case studies published in the Journal of Thoracic Oncology revealed insight into an early phase of pulmonary pathology of the novel coronavirus (severe acute respiratory syndrome coronavirus 2; COVID-19) pneumonia. The studies focused on two patients who had recently undergone a lung lobectomy and were later determined to have been positive for COVID-19 at the time of surgery.
“Pathologic examinations revealed that apart from the tumors, the lungs of both patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells,” noted Sufang Tian, MD, PhD, of the Zhongnan Hospital of Wuhan University, China, and colleagues.
The first case was an 84-year-old woman with type 2 diabetes and a prolonged history of hypertension. She underwent thoracoscopic resection 6 days after a CT scan confirmed bilateral ground-glass opacity in addition to a tumor in the right middle lobe. The changes to the nontumor lung parenchyma “represent at least the peripheral part of COVID-19 pneumonia.” She experienced difficulty breathing, chest tightness, wheezing, and decreased oxygen saturation 4 days after surgery and tested positive for COVID-19 12 days after surgery. The patient entered a coma 15 days after surgery and died 2 days later, never having developed a fever.
The second case was a 73-year-old man with an extended history of hypertension who underwent right lower lobe lung resection with lymph node dissection. A CT scan performed 2 days after surgery revealed ground-glass opacity in the right upper lobe; the patient was discharged 6 days after surgery. He developed a fever, dry cough, and chest tightness 9 days after surgery and tested positive for COVID-19, prompting readmittance. After 20 days of treatment, he recovered and was discharged.
Disclosure: The study authors reported no conflicts of interest.
