In this chapter, echocardiographic features of acute aortic syndromes including acute aortic dissection, aortic intramural hematoma and aortic penetrating ulcer are presented. Real-world case examples are used to illustrate the diagnostic features of these conditions. Complementary roles of other cardiac imaging modalities such as cardiac computed tomography and cardiac magnetic resonance imaging are discussed. Management strategies with reference to current clinical practice guideline recommendations are also discussed.