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A 20-year-old man who served as a midshipman presented to our cardiology clinic after a chest radiograph that had been obtained as part of the physical examination for military-officer commissioning was found to be abnormal. He said he had no symptoms, and the results of a physical examination were normal. The chest radiograph (Panel A) showed a smoothly marginated density in the region of the right cardiophrenic angle that partially obscured the right border of the heart. A computed tomographic scan (Panel B) showed a homogeneous and smooth lesion with no septations or calcifications: it measured 5.0 by 4.4 by 7.0 cm and abutted the right border of the heart. The heart and great vessels were otherwise normal, and there was no adenopathy. An echocardiogram (Panel C) was obtained for further evaluation of the lesion. A modified right parasternal view confirmed the presence of a fluid-filled pericardial cyst. Given the midshipman's absence of symptoms and the benign nature of pericardial cysts, this incidental finding was followed clinically. RV denotes right ventricle, and RA right atrium.
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