Abstract
OBJECTIVES:Ultrasound-guided minimally invasive autopsies (MIA-US) are an alternative to conventional autopsies and have been used in our institution to investigate the pathophysiology of COVID-19 since the beginning of the pandemic. Owing to the limitations of post-mortem biopsies for evaluating cardiopulmonary events involving large vessels, we continuously improved the technique during this period. Objectives: To demonstrate the usefulness of an extended MIA-US technique (EMIA-US) for the study of thoracic involvement in COVID-19.METHOD:US-guided percutaneous tissue sampling was combined with a small thoracic incision (≤5 cm), allowing for the sampling of larger tissue samples or even the entire organ (lungs and heart).RESULTS:EMIA-US was performed for eight patients who died of COVID-19 in 2021. We demonstrate cardiopulmonary events, mainly thromboembolism and myocardial infarction, that could be evaluated using EMIA-US.CONCLUSIONS:Minimally invasive image-guided post-mortem tissue sampling is a flexible and practical method to conduct post-mortem studies of human diseases, mainly in areas that do not have autopsy facilities or, alternatively, when autopsy is not possible owing to financial constraints, cultural and religious values, or for safety reasons, such as in the case of highly contagious infectious diseases. We present evidence that EMIA-US is feasible and can be used as an alternative to increase the accuracy of MIA-US in detecting cardiopulmonary events involving large vessels, which may not be assessed through post-mortem biopsies.
Highlights
Invasive autopsy (MIA) is an alternative to conventional autopsies in some situations
extended Minimally invasive autopsy (MIA)-US technique (EMIA-US) was performed in eight patients who died of severe COVID19
EMIA-US was created owing to the need to investigate thrombotic and ischemic cardiopulmonary events, which are important aspects of the pathogenesis of severe COVID-19
Summary
Invasive autopsy (MIA) is an alternative to conventional autopsies in some situations. In areas devoid of autopsy facilities, MIA is used to establish the cause of death, especially in the context of infectious conditions (1,2). The portability of MIA offers a unique opportunity to conduct autopsy in distant settings such as that in Brazil since the 1920s, a period in which a special device, the viscerotome, was employed in the investigation of the pathogenesis of yellow fever and other infectious diseases, such as leishmaniasis and schistosomiasis (3). Received for publication on September 29, 2021. Accepted for publication on October 20, 2021
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