**Abstract**

Aortic dissection remains one of the rare but life-threatening causes of chest pain presenting to the emergency department. High index of suspicion is required for prompt diagnosis of the cases presenting to the ED. Symptoms may vary with extent and the progression of the dissection and may further complicate the diagnosis. Thus, patients may present with features of acute MI, CVA, or other end-organ ischemia. Hypertension at presentation may be an important clue for diagnosis of underlying dissection. In low risk patients, D dimer may become a useful screening tool. In patients with high index of suspicion, the choice of investigation will depend on the overall stability of the patient and extent of end-organ ischemia. Stable patients may benefit from CT angiography due to its widespread availability and speed of acquisition. Diagnosis may be challenging for hemodynamically unstable patients in centers where the resources are limited. Transesophageal echocardiography may provide diagnosis in such patients at bedside or in the emergency department. Prompt investigations are required to accurately define the type and extent of damage so that the patient receives life-saving measures in a timely manner.

**Keywords:** aortic dissection, D dimer, CT angiography, transesophageal echocardiography
