The term “acute aortic syndrome” was introduced into emergency medicine in similarity to the term “acute coronary syndrome” and aims to summarize acute life-threatening diseases caused by acute aortic diseases (Vilacosta and Roman 2001). The most commonly used definition of acute aortic syndromes includes the classical aortic dissection, the intramural hematoma without intimal tear (IMH), the penetrating atherosclerotic ulcer (PAU) as well as the iatrogenic/traumat ic aortic rupture, and the symptomatic/ruptured aortic aneurysm (Erbel et al. 2001; Erbel et al. 2014; Maddu et al. 2014). Despite the fact that different pathomechanisms are responsible for the diseases listed above, the clinical connection between these diseases is defined by the typical, severe “aortic” pain and the acute danger for life representing a syndrome in need for absolutely urgent diagnosis and treatment to save patients life. From a diagnostic point of view, the link between the different diseases is represented by the primary intimal lesion causing the acute aortic syndrome. Consequently, the exact differential between the different entities summarized as “acute aortic syndromes” (e.g., between a localized dissection and a penetrating ulcer) is not mandatory in the acute setting. The only really necessary task to be fulfilled in the acute situation is the recognition and the localization of the acute aortic syndrome (see below).