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We report a unique case, which had combinations of rare findings like 1] recurrence of constrictive pericarditis in a patient who underwent pericardiectomy in the past, 2] calcification of residual pericardium in the atrio-ventricular groove like a ring leading to constriction of mitral and tricuspid valvular inlets, 3] presence of localized air all along the ring in the atrio-ventricular [AV] groove secondary to communicating broncho-epicardial fistula, 4] multiple tuberculous abscesses presented as collections surrounding the cardiac and mediastinal structures. The extensive tuberculous involvement of cardio-respiratory-mediastinal structures, which had a florid clinical presentation, and despite medical stabilization and surgical intervention, patient could not be saved. Indian subcontinent still has tuberculosis as an endemic disease, which involves socio-economically poor people, particulars those work in industrial areas. These combinations of clinico-pathophysiological findings as in our case were not reported in the literature.