Diseases of the aorta is a well-recognized entity in cardiovascular medicine. While traditionally they were thought to be mostly secondary to aortic valve disease and localized coarctation of the aorta, recent scientific evidence supports many of the aortic syndromes to be hereditary and need specific clinical management protocols. Acute aortic dissection is a surgical emergency once the diagnosis is made. A number of classifications exist, the simplest of which classifies aortic dissection according to the location of the entry point into: type “A,” which involves all forms that include the ascending aorta, and type “B,” which does not involve the ascending aorta. While type “A” is always an emergency diagnosis and management, type “B” can be managed medically or conservatively. Mortality from type “A” dissection may be up to 60% within the first 24 hours, 80% over the first 2 weeks, and 90% within 3 months of acute attack. Dissection of the proximal ascending aorta can often be seen on transthoracic echo imaging, and even those involving the distal ascending aorta may also be detected.