Late Complications of COVID-19 A Morphologic, Imaging, and Droplet Digital Polymerase Chain Reaction Study of Lung Tissue

Anja C. Roden, Jennifer M. Boland, Tucker F. Johnson, Marie Christine Aubry, Ying Chun Lo, Yasmeen M. Butt, Joseph J. Maleszewski, Brandon T. Larsen, Henry D. Tazelaar, Andras Khoor, Maxwell L. Smith, Teng Moua, Sarah M. Jenkins, Ann M. Moyer, Eunhee S. Yi, Melanie C. Bois

Research output: Contribution to journalArticlepeer-review


Context.—Studies of lungs in patients with COVID-19 have focused on early findings. Objective.—To systematically study histopathologic and imaging features and presence of SARS-CoV-2 RNA in lung tissue from patients in later stages of COVID-19. Design.—Autopsies, explants, surgical lung biopsies, transbronchial biopsies, cryobiopsies, and needle biopsies from patients with COVID-19 whose onset of symptoms/confirmed diagnosis was more than 28 days before the procedure were studied. Available images were reviewed. Reverse transcription droplet digital polymerase chain reaction for SARS-CoV-2 RNA was performed on lung tissue. Results.—Of 44 specimens (43 patients; median age, 59.3 years; 26 [60.5%] male) features of acute lung injury (ALI) were seen in 39 (88.6%), predominantly organizing pneumonia and diffuse alveolar damage, up to 298 days after onset of COVID-19. Fibrotic changes were found in 33 specimens (75%), most commonly fibrotic diffuse alveolar damage (n = 22) and cicatricial organizing pneumonia (n = 12). Time between acquiring COVID-19 and specimen was shorter in patients with diffuse ALI (median, 61.5 days) compared with patients with focal (140 days) or no ALI (130 days) (P = .009). Sixteen (of 20; 80%) SARS-CoV-2 reverse transcription droplet digital polymerase chain reaction tests were positive, up to 174 days after COVID-19 onset. Time between COVID-19 onset and most recent computed tomography in patients with consolidation on imaging was shorter (median, 43.0 days) versus in patients without consolidation (87.5 days; P = .02). Reticulations were associated with longer time to computed tomography after COVID-19 onset (median, 82 versus 23.5 days; P = .006). Conclusions.—ALI and SARS-CoV-2 RNA can be detected in patients with COVID-19 for many months. ALI may evolve into fibrotic interstitial lung disease.

Original languageEnglish (US)
Pages (from-to)791-804
Number of pages14
JournalArchives of Pathology and Laboratory Medicine
Issue number7
StatePublished - Jul 2022

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology


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