All variants of acute aortic pathology must be considered in the differential diagnosis of the patient presenting with an acute aortic syndrome. In addition to classic aortic dissection, this syndrome includes intramural aortic hematoma and penetrating aortic ulcer. The diagnosis of these two last lesions, which lack a mobile intimomedial flap and a double aortic lumen, is difficult. In this review, some anatomical and diagnostic aspects of the acute aortic pathology are discussed to help to better identify these patients.