Horseshoe lung is an uncommon congenital malformation in which the bases of the right and the left lungs are fused to each other by a narrow isthmus posterior to the cardiac apex. So far 22 cases have been described: most of these were associated with right lung hypoplasia and the scimitar syndrome. A horseshoe lung anomaly with left lung hypoplasia is described.The term horseshoe lung was first used by Spencer in 1962 to describe a malformation in which an isthmus of pulmonary parenchyma extends from the right lung base across the midline behind the pericardium and fuses with the base of the left lung.' After this first reported case, 21 more were reported.2 Most of these cases were associated with hypoplasia of the right lung, dextrarotation of the apex of the heart, and abnormal drainage of the right pulmonary veins into the right atrium.We describe our experience with a 2 l/2 year old girl who had horseshoe lung with left lung hypoplasia, a ventricular septal defect, and severe pulmonary hypertension. Because of persistent severe infection and rapid deterioration of the patient an emergency left posterolateral thoracotomy was performed. At thoracotomy the left hemithorax was completely occupied by the heart. In the left retrocardiac space atelectatic pulmonary tissue 1-5 cm in diameter was observed. After the surrounding tissues had been dissected abnormally lobulated lung tissue was identified. This could be pulled into the left hemithorax through the inferoposterior cardiac space. There were no hilar structures that belonged to this lung tissue with its abnormal origin. Because full expansion of this atelectatic lung tissue was maintained with positive pressure ventilation resection was not carried out. Instead the lung tissue was fixed to the left hemithorax and pericardium. In the early postoperative period the cyanosis disappeared, blood gas values improved, and a chest radiograph showed that mediastinal shift was nearly corrected and atelectatic segments were re-expanded (fig 2). Two weeks after the operation angiography and cardiac catheterisation were performed to investigate the heart murmur. During angiography the left pulmonary artery was not observed, but small collaterals arising from main pulmonary artery were seen. There were also some collaterals originating from the right pulmonary artery, supplying the left lung (fig 3). During angiography a ventricular septal defect and a patent foramen ovale were

Cavernous hemangiomas of the anterior mediastinum is rare. We present a case of a 56-year-old male patient with a giant cavernous hemangioma of the anterior mediastinum, 18 cm in diameters, approached by left posterolateral thoracotomy. To the best of our knowledge, such a unique case has not been previously presented in the literature.

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While most pleural neoplasms are malignant and associated with asbestos exposure, benign tumors may also occur. Benign fibrous tumors of the pleura are rare and, unless diagnosed and resected early, they may reach an enormous size and cause severe symptoms. We report the case of a pregnant woman with a giant benign fibrous tumor localized in the pleura.

Aim of the studyTo study the effect of thyroid transcription factor-1 (TTF-1) expression on ipsilateral mediastinal nodal (N2) metastases in primary adenocarcinoma of the lung.Material and methodsThe patients operated on with a diagnosis of primary adenocarcinoma of the lung were retrospectively analyzed and divided into two groups according to their TTF-1 expression. The relationship between TTF-1 expression and N2 metastases was evaluated.ResultsThere were 73 patients (58 male, 15 female) with a mean age of 58.4 ±10.2 in the study group. Sixty-six lobectomies or pneumonectomies and mediastinal lymph node dissection, and seven mediastinoscopies were performed. Positivity of the TTF-1 protein expression detected by the immunohistochemical staining of the specimens was present in 33 patients (45.2%); these patients were classified as group A and the rest of the patients as group B. Eleven patients had N2 disease in group A versus five patients in group B and the difference between the two groups was statistically significant.ConclusionsPatients with primary adenocarcinoma of the lung having TTF-1 expression are more likely to have N2 disease. They might be considered as candidates for adjuvant therapy.