Liu Liang's autopsy report released: lesions still focus on evidence of damage to other lung organs
Pathological anatomy of the dead body of neo-pneumococcal pneumonia can provide strong support for clinical treatment and diagnosis.
The autopsy report was released 12 days after the dissection of the first patient with new coronary pneumonia, and it was clearly stated that the lesions of the new coronary pneumonia still focused on the lungs and there was insufficient evidence of damage to other organs.
The "Journal of Forensic Medicine", Vol. 36, Issue 1, February 2020, pre-published "A General Observation Report on the Anatomy of the Dead Corpse of New Coronavirus Pneumonia" (hereinafter referred to as the "Report"). Liu Liang, a professor of the Department of Forensic Medicine of Tongji Medical College of Huazhong University of Science and Technology, is the main person responsible for the anatomy of the remains.
The "Report" results suggest that neocoronary pneumonia mainly causes inflammatory reactions characterized by deep airway and alveolar damage. Pulmonary fibrosis and consolidation are less severe than those caused by SARS, and exudative reactions are more pronounced than SARS. Whether the adventitia, kidney, spleen, digestive tract organs, and brain are associated with viral infections remains to be further studied.
As early as January 22, Liu Liang called for pathological anatomy of the patients with new coronary pneumonia, and joined the team to submit emergency reports to relevant departments, emphasizing the importance of pathological anatomy. Liu Liang believes that pathological anatomy of the dead body of neo-pneumococcal pneumonia can provide strong support for clinical treatment and diagnosis.
Liu Liang has been involved in pathological research for more than 30 years. After the outbreak of new crown pneumonia, his team submitted an emergency report to the Hubei Provincial Government, emphasizing the importance and feasibility of autopsy, and received affirmative approval.
At about 3 am on February 16th, the autopsy of the first patient who died of new crown pneumonia in the country was completed at Wuhan Jinyintan Hospital, and the pathology of new crown pneumonia was successfully obtained. At 18:45 pm on the same day, the autopsy of the second patient who died of new pneumonia in the country was also successfully completed in Jinyintan Hospital. The Liu Liang team undertook these two dissection tasks.
At 23:12 on February 16th, Liu Liang posted a post on his personal headline account "Forensic Doctor Liu Liang" detailing the course of two consecutive autopsy of neo-crown pneumonia in 18 hours.
In an interview with CCTV on February 24, Liu Liang stated that Academician Zhong Nanshan had called himself on the morning of the 24th and said that the frontline doctor would wait for the results of the autopsy, otherwise he would not know what to do with the treatment and how to evaluate the treatment effect.
Liu Liang also said that preliminary results had begun in the early hours of February 24. The preliminary results are being discussed internally to form a consensus.
The "Report" stated that the lungs of the deceased were obvious, and the inflammatory lesions (grey-white lesions) were weighted to the left lung. The macroscopic view of the lungs was patchy, gray-white lesions and dark red bleeding were visible, the texture was tough, and the lung's inherent sponge was lost. sense. A large number of sticky secretions overflowed from the alveolar surface and fibrous strands were seen on the section. A control review of the CT scan of the patient on the 20th day of admission showed multiple patchy ground glass shadows on both lungs, air bronchus signs, weight on the left side, and fibrous cord shadows on both lower lungs.
Therefore, the "Report" considers that considering that the ground-glass opacities seen in imaging correspond to the gray-white alveolar lesions seen with the naked eye, it suggests that neo-coronary pneumonia mainly causes inflammatory reactions characterized by deep airway and alveolar damage.
The local pathological changes of the tissue obtained from the corpse puncture sampling of the dead of New Coronary Pneumonia suggest that the pathological characteristics of New Coronary Pneumonia are very similar to those caused by SARS and MERS Coronavirus, but from this systemic anatomy, the fibrosis and consolidation of the lung were not observed The disease caused by SARS is severe, and the exudative response is more obvious than SARS. It is considered that this patient may be only 15 days from diagnosis to death and the short course of disease. More systematic autopsy data and histopathological verification are needed.
In addition, the report found that the pleural effusion of the deceased was not much, pale yellow clear liquid, and no large amount of pleural effusion was seen, suggesting that pleural lesions were not mainly serous inflammation. Severe adhesion of the right lung to the pleura suggests that this case may be complicated by infectious pleurisy. Due to the clinical data of the patients, there is a history of coronary heart disease and angina pectoris. Whether the myocardium and epicardium are associated with viral infection needs to be further studied.
In addition, this case of digestive system damage is not obvious to the naked eye. It is worth mentioning that the small intestine is segmentally dilated and narrowed (similar to beaded), and it is a case or a general manifestation that requires more autopsy. There were no obvious abnormalities in the spleen to the naked eye. Histopathological studies were needed to determine the presence of lesions. The kidney has a granular, condensed kidney appearance, which is considered to be related to the underlying disease.
Regarding the nervous system, visual observation of brain edema and mild atrophy of the cerebral cortex, combined with clinical data, the patient was older, had multiple cerebral infarctions and sequelae of cerebrovascular disease, and no visual infection-specific manifestations of the brain were observed. Does the virus invade the central nerve The system is to be verified by histopathology.
First Financial Reporter Ma Xiaohua