Transesophageal echocardiography (TEE) has become a widely used imaging technique for evaluating cardiac structure, function, and valvular anatomy. Transesophageal echocardiography has also provided a new perspective on the thoracic aorta, and there is growing evidence that the technique contributes valuable and sometimes unique information about aortic structure and pathology. Recently introduced multiplane transesophageal probes have improved visualization of the proximal and transverse aorta, but few comprehensive discussions of TEE's application in aortic disease exist. Therefore, we have reviewed the published literature and our institutional experience in transesophageal aortic ultrasonography. The available evidence strongly supports the use of TEE in aortic dissection and atherosclerosis and suggests potential utility in additional diseases of the aorta such as aneurysm, ulceration, trauma, and congenital or inherited malformation.