Aortic dissection (AD) is a life-threatening emergency that has a mortality rate of around 27% even when optimal conditions are met. Atypical process of the disease which can mimic other critical conditions makes it harder to diagnose. The study aimed to determine Emergency department presentations and factors that influence the diagnostic process, emergency department, and in-hospital mortalities of acute AD patients. This study is a single-centered retrospective observational study. Patients with ICD-10 codes for AD in their digital files were analyzed. Patients were categorized into Stanford Type A or B dissections according to their computerized tomography scans. Also, the patients were compared in terms of survival. Eighty-eight patients had an acute AD and the mean age was 61,90±12,67 years. According to Stanford Classification, 68 patients had Type A dissection. Altered mental status and syncope were detected more in Type A (p=0.003 and p=0.001). Bilateral arm blood pressure readings differential was more in Type A (p=0.007). Blood products were used and endotracheal intubation was performed more in Type A (p=0.002 and p=0.005). Patients who had bilateral arm blood pressure differential had 3.5-fold, who had developed cardiac arrest in ED had 5.07-fold, who got blood product transfusions had 5.41-fold more risk of death. [OR:3.50; (CI 95% 1.36-8.94) p=0.009, OR: 5.07; (CI 95% 1.18-21.39) p=0.027 and OR: 5.41; (CI 95% 1.97-14.78) p=0.001 respectively]. The mortality rates in ED and in-hospital were 12.5% and 61.4% respectively. Aortic dissections will stay as important clinical conditions which management in ED is crucial. Atypical presentation of AD and the nature of the disease cause delays in diagnoses. AD should be considered in the foreground in patients presenting with syncope and altered mental status. When there is a clinical suspicion the scan of the aorta with computerized tomography must be ordered rapidly.