This patient presents with chest pain. What’s the diagnosis?

This 32 yr old patient presents with chest pain. Based on the pictures, can you diagnose what the most likely cause is?

Marfan 1

Marfan 2

The cause of chest pain is Aortic dissection. This is a patient with Marfan’s Syndrome. A majority of adults with Marfan’s syndrome have aortic dilation and if untreated can lead to aortic dissection. The above pictures show a positive thumb sign where the thumb protrudes past the lateral aspect of the hand. The second picture is referred to as a positive wrist sign where again the elongated fingers are shown as the entire nail of the index finger is covered by the thumb. This test is even more specific using the 5th digit.