Emphysema and aortic dissection in Marfan syndrome

This 25-year-old male patient with a history of Marfan syndrome had undergone prior dissecting aneurysm repair and presented with acute chest pain.
(A) PA chest x-ray.
(B) Lateral chest x-ray. Note the gracile osteopenic appearance of the ribs, consistent with Marfans syndrome. Note also the hyperinflated lungs consistent with emphysema. These studies were taken after surgery for a dissecting aortic aneurysm; note the metallic surgical sutures in the sternum.
(C) CT, mid-thorax. Note the descending aortic dissection with a false lumen with contrast (arrow) and non-effaced true lumen with contrast and surrounding thrombus.