Acute aortic syndromes include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer. These are potentially life-threatening abnormalities of the aorta requiring immediate evaluation by the cardio-thoracic surgery service. CT angiography is the most appropriate imaging modality in the acute setting to detect and diagnose the disease and assess its severity. Precontrast and postcontrast imaging should be obtained of the entire aorta from thorax to pelvis. After aortic rupture, the most severe complication is visceral ischemia from hypoperfusion. Dissections should be systematically searched for and may be amenable to endovascular treatment.