Coronary artery thromboembolism and unexpected death in childhood and adolescence

Two cases of unexpected death in childhood and adolescence associated with coronary artery thromboembolism are reported involving a 6-year-old girl with acute rheumatic fever and left ventricular vegetations, and an 18-year-old adolescent with Down syndrome and congenital heart disease. Although coronary artery thromboembolism is rarely reported in childhood or adolescence, these cases demonstrate that careful examination of the coronary arteries during pediatric autopsy may be helpful in determining factors contributing to death, even at quite young ages. This is particularly so in the presence of predisposing cardiac pathology.