Congenital pericardial cyst in a naval special warfare candidate; clearance for diving after resection

We report the case of a 19-year-old male military recruit who presented for a screening physical for U.S. Naval Special Warfare and Diving Duty. During his screening physical examination, an exophytic pericardial cyst was discovered. Subsequent work-up revealed normal cardiopulmonary function despite this large 7-cm mass, but the candidate was disqualified due to concerns regarding the risk of complications. He underwent successful elective surgical resection without post-operative complications. One year post-operatively, he repeated his cardiopulmonary work-up with normal results and successfully completed training.

Literature search was conducted using PubMed/Medline. Keywords included pericardial/um, cyst, mediastinum, special operations, military, diving, thoracoscopy/ic resection. Results that included cases of pericardial cysts or other mediastinal tumors were included.

Review of the literature reveals that complications are rare and range widely in severity. Analysis of the physiology of diving, together with absence of reported cases, suggest that there is little to no, increased risk in recreational scuba diving for subjects with asymptomatic lesions. While no cases of morbidity or mortality have been reported in elite athletes, the severe and repetitive trauma experienced by Special Operators raises clinical concern for these lesions.

Because of the increased risk of morbidity and mortality in the Special Operations environment, clearance for duty should not be granted those individuals. However, in the general population, as well as with low-impact activities such as recreational scuba diving, periodic observation without resection seems reasonable.