Review Question - QID 214443

A 24-year-old man is brought to the emergency department by ambulance after he was found passed out in the middle of the street around midnight. On presentation, he complains of severe pain in the center of his chest that started just before he passed out. He says that he was drinking heavily throughout the night and vomited several times prior to passing out. His past medical history is significant for an unprovoked pneumothorax when he was 17, and family history is significant for a cousin who died at age 14 because of "problems with his aorta." On physical exam, he is 6'7" with long extremities, and he is in significant distress. Palpation over the chest wall demonstrates crepitus, and blood and vomit covers his clothing. Cardiac exam reveals crackling sounds in the left lateral decubitus position. Which of the following is most likely responsible for this patient's symptoms?