Acute aortic syndromes can either be spontaneous or traumatic and are often difficult to diagnose. Delayed diagnosis and misdiagnosis of acute aortic syndromes contribute to significant morbidity and mortality. Images of the aorta can be obtained by transthoracic and transabdominal views and by TEE. Diagnostic accuracy of POCUS for acute aortic processes can be useful but cannot exclude the absence of pathology in symptomatic patients. For patients with a high pretest probability of an acute aortic process but a negative POCUS exam, formal imaging is suggested, such as CTA.