Background Coronavirus disease 2019 (COVID-19) has claimed the lives of millions of people globally. Aims This study aims to identify the pathological findings at autopsy of asymptomatic COVID-19 death, to compare the incidence of acute bilateral pulmonary thromboembolism (ABPTE) in asymptomatic COVID-19 deaths versus non-COVID-19 deaths and to explore the possible pathogenesis of thrombosis in COVID-19. We also consider the place of COVID-19 in the death certification of 4 cases who died from ABPTE. Methods This study primarily reviewed post-mortem reports of 6 asymptomatic COVID-19 deaths. Post-mortem reports for the years 2019 and 2020 were also reviewed to establish the incidence of ABPTE. Each post-mortem report was reviewed for gross examination, histology and toxicology findings. A literature review on COVID-19 autopsy findings, COVID-19 pathogenesis, thrombosis in COVID-19 and asymptomatic SARS-CoV-2 infection was also conducted using PubMed. Results Of the 6 asymptomatic COVID-19 deaths, 4 died as a result of ABPTE, 1 died of ischaemic and hypertensive cardiac disease caused by coronary artery disease and ventricular hypertrophy and the remaining case died of heart failure due to dilated cardiomyopathy caused by subendocardial fibrosis. There were 2 cases of bilateral pulmonary thromboembolism (BPTE) in 2019 out of 140 post-mortems. Excluding the 4 cases of ABPTE described already, there was 1 case of ABPTE in 2020 out of 156 post-mortems. A literature review on the pathogenesis of thrombosis in COVID-19 highlighted the significant role that the endothelium plays. Conclusions Massive pulmonary thromboembolism may be a significant cause of death in asymptomatic COVID-19 infection.
【저자키워드】 COVID-19, SARS-CoV-2, thrombosis, Asymptomatic, Pulmonary thromboembolism, 【초록키워드】 Coronavirus disease 2019, Pathogenesis, SARS-COV-2 infection, Infection, fibrosis, Autopsy, Endothelium, Coronary artery disease, heart failure, COVID-19 pathogenesis, Thromboembolism, death, Post-mortem, incidence, cardiac disease, Cardiomyopathy, histology, deaths, Asymptomatic COVID-19, literature review, Non-COVID-19, hypertensive, massive, Result, described, identify, caused, died, conducted, pathological finding, claimed, ventricular, 【제목키워드】 Thromboembolism, Asymptomatic COVID-19,