The diagnosis of ascending aortic aneurysm, its precise assessment criteria and indications for surgery represent a chapter of great stimulus and interest for the clinical cardiologist. There are many factors influencing the classification of patients, but it is the contemporary evolution of knowledge in this field that contributes to a more global view of the aorta. The approach is increasingly multidisciplinary, both in clinical and genetic terms, and multimodal imaging is a crucial support for therapeutic decisions and monitoring. All these aspects, together with the most recent developments, will be explored and reasoned about in this review.