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 an d 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 affe cting the apical region of her right lower lobe, with regional hilar l ymphadenopathy. 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 po rtions of both coronary arteries, resulting in obstruction of the coro nary arteries in addition to the left ventricular outflow tract. The c onsequent myocardial fiber hypertrophy and interstitial fibrosis predi sposed the patient to the development of fatal arrhythmias that most p robably accounted for her sudden death.