The Computer-Tomographic Semiotics, Volume of Lung Damage and Morphological Comparisons in Patients with Severe and Extremely Severe Coronavirus Pneumonia (COVID-19)

We retrospectively analyzed the chest CT data performed on a multislice CT 1–2 days before death; 63 deceased patients of both sexes aged 27 to 96 with COVID-19-induced severe and extremely severe pneumonia. All patients underwent autopsy with a histological examination. Material for CT and histological comparisons was taken from 14 deceased patients. The average gender distribution by age is 68,5 ± 17,8, for men the average age is 40 (63,5 %), for women — 23 (36,5 %). We identified 15 X-ray semiotic signs of COVID-19-induced pneumonia. «Frosted glass» syndrome, «cobblestone» syndrome and «consolidation» were observed in 100 % cases. The frequency of other signs ranged from 1,6 % to 95,2 %. The average volume of lung damage was 56,63 ± 19,17 with a range from 12 to 90 %. According to the CT scale, the volume of damage fluctuated: CT1 — 7,9 %, CT2 — 36,5 %, CT3 — 41,3 %, CT4 — 14,3 %. The number of patients (55,6 %) with more than 50 % lung damage prevailed. Both lungs were involved in the inflammatory process in 100 % cases, the lower lobes were affected by 100 %, the middle lobes were affected by 80 %, and the upper ones by 43 %. The peripheral and posterior parts were damaged more often than the central and anterior ones. In the age group of patients up to 65, the volume of lung damage was much more significant than in patients over 65. The need for mechanical ventilation was significantly greater in case the volume of lung damage was more than 50 %, other clinical factors did not have significant importance. The lethal outcome among patients with coronavirus pneumonia occurred with both insignificant and extensive lesions. Histological studies of the lung tissue indicated the presence of diffuse alveolar damage with the development of an exudative, exudative-proliferative or proliferative phase. 

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