A high-resolution 3D atlas of the spectrum of tuberculous and COVID-19 lung lesions

Our current understanding of the spectrum of human lung lesions caused by TB and COVID-19 is limited by a reliance on low-resolution imaging platforms that provides limited spatial insight and lacks true-to-life 3D representations of lesion types within the context of the whole lung. Here, we leverage micro/nano computed tomography for the 3D characterization of human tuberculous and COVID-19 lesions from surgically resected and postmortem lung tissue. We establish an atlas that defines a spectrum of pathologies including cavitary lesions, calcium deposits outside and inside necrotic granulomas, mycetomas, vascular rearrangement, and lesions within paraffin-embedded TB tissues. Notably, segmentation of pathological anomalies revealed hidden pathological structures that might otherwise be disregarded, demonstrating a powerful method to visualize pathologies in 3D in TB lung tissue and whole COVID-19 lobes. These findings provide unexpected new insight into the spatial organization of the spectrum of TB and COVID-19 lesions within the framework of the whole lung.