Tuberculous aortitis with coronary ostial and left ventricular outflow obstruction: Unusual cause of sudden unexpected death

Tuberculous aortitis is a distinct, but uncommon, cause of thoracic and abdominal aortic aneurysms. We report an unusual case of tuberculous aortitis in a 12-year-old girl that resulted in her sudden death. The patient suffered from undiagnosed primary pulmonary tuberculosis affecting the apical region of her right lower lobe, with regional hilar lymphadenopathy. The granulomatous inflammatory process spread from the hilar lymph nodes to the aortic root, leading to tuberculous aortitis and the formation of an intraluminal tuberculoma just superior to the aortic valve. The tuberculoma also involved the ostia and proximal portions of both coronary arteries, resulting in obstruction of the coronary arteries in addition to the left ventricular outflow tract. The consequent myocardial fiber hypertrophy and interstitial fibrosis predisposed the patient to the development of fatal arrhythmias that most probably accounted for her sudden death.