The diagnosis and follow-up of acquired thoracic aortic disease have greatly improved with advances in transthoracic and transoesophageal echocardiographic techniques. In emergency situations, transoesophageal echocardiography is the key diagnostic investigation for dissection, significantly speeding up surgical referral. Atherosclerosis of the aorta is the second clinical situation in which transoesophageal echocardiography confirms its superiority over other imaging techniques for the recognition of intra-aortic debris carrying a high embolic risk.