The advances made in recent years in the medical and surgical management of tuberculosis have prompted a renewed interest in a form of tuberculosis which mainly affects the aorta. The disease, while uncommon, is important because it will lead to serious consequences if untreated. Generally, the aorta becomes involved by direct extension from periaortic foci such as tuberculous lymph nodes or psoas abscesses and this finally results in aneurysm formation or perforation or both. Fatal complications can be prevented by early recognition and prompt surgical intervention. These principles are illustrated by the case histories of a woman aged 25 and 2 men aged 59 and 60 years.