Ultrasound as a diagnostic tool is a portable, non-invasive, and cost-effective tool which can be utilized in real time at the bedside. Transesophageal echo (TEE) circumvents the limitations that the chest wall poses on image acquisition, making its ability to acquire high-resolution images within critical care setting invaluable. However, like transthoracic echocardiography, understanding imaging artifacts are an integral part of image acquisition and interpretation. There are five universal assumptions fundamental to the generation of an ultrasound image. Artifacts occur when these assumptions are violated. In TEE, many of these artifacts are predictable and thus misinterpretation can be avoided. This chapter will summarize common artifacts in TEE with a focus on imaging of the thoracic aorta, review of artifacts specific to three-dimensional (3D) imaging, and common anatomical variants so as to avoid pitfalls.