Traumatic calcific nonconstrictive pericarditis

A 65 year old woman is described who, 22 years after a steering wheel injury to the chest, was found to have a severe pectus excavatum, a heart completely torn free of its diaphragmatic attachments and with heavy pericardial calcification. Despite evidence of severe cardiac damage, she had only minimal impairment of cardiac function. Angiocardiographic findings are presented. Cardiac catheterization revealed no evidence of restriction, but there was a small systolic pressure gradient from right ventricle to pulmonary artery. Possible causes of the anatomic and functional findings are discussed.