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Objective The purpose of our study was to assess the differentially diagnostic value of radiographic characteristics of pure ground glass nodules (GGNs) between minimally invasive adenocar-cinoma and non-invasive neoplasm. Methods Sixty-seven pure GGNs (28 minimally invasive adenocarcinomas (MIA) and 39 pre-invasive lesions) were analyzed from June 2012 to June 2015. Pre-invasive lesions consisted of 15 atypical adenomatous hyperplasia (AAH) and 24 adenocarcinomas in situ (AIS). High-resolution computed tomography (HRCT) features and volume of MIA and pre-invasive lesions were assessed. Fisher exact test, independent sample t test, Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were performed. Results Inter-observer agreement indexes for the diameter, mean HRCT attenuations and volume of pure GGNs were all high (ICC>0.75). Univariate analyses showed that lesion diameter, mean HRCT attenuation, and volume value differed significantly between two groups. Among HRCT findings, GGN shape as round or oval (F = 13.456, P = 0.002) and lesion borders as smooth or notched (F = 15.742, P = 0.001) frequently appeared in pre-invasive lesions in comparison with MIA. Type II and type III of the relationship between blood vessels and pure GGNs suggested higher possibility of malignancy than type I. (2017) Can we differentiate minimally invasive adenocarcinoma and non-invasive neoplasms based on high-resolution computed tomography features of pure ground glass nodules? PLoS ONE 12(7): e0180502. https://doi.org/10.

Bronchiolitis obliterans (BO) or bronchiolitis obliterans organizing pneumonia (BOOP) is one of manifestations of graft-versus-host disease (GVHD), a complication of hematopoietic stem cell transplantation (HSCT). Recently there are reports about thoracic air-leakage syndrome (TALS), but real incidence, clinical course, and implications of TALS remain unclear. Retrospective review of 18 TALS patients among 2,177 patients who received allogeneic HSCT between January 2000 to July 2007 was done. Clinical manifestations, treatments, and outcomes of TALS were reviewed. The incidence of TALS was 0.83% (18/2,177). The onset of TALS was mean 425.9±417.8 days (60-1,825 days) after HSCT, and the duration was mean 16.3±21 days (2-90 days). The most common types of TALS were spontaneous pneumothroax (n=14), followed by subcutaneous emphysema (n=6), pneumomediastinum (n=5), interstitial emphysema (n=2), and pneumopericardium (n=1). TALS persisted in six patients, who died during the same hospitalization. The 12 patients recovered from TALS, but only 2 survived, while others died due to aggravation of GVHD. TALS may complicate BO/BOOP and be an initial manifestation of BO/BOOP. TALS is hard to be resolved, and even after the recovery, patients die because of aggravation of GVHD. We suggest specifically in HSCT patients, when once developed, TALS seems hard to be cured, and as a result, be related to high fatality.

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