Extracranial internal carotid artery aneurysms are rare. They may result in thromboembolic phenomena but spontaneous rupture is rare. The clinical presentation may be an asymptomatic neck mass or there may be symptoms of upper aerodigestive tract compression. The diagnosis may be suspected on clinical examination but radiologic investigations play an important role in diagnosis, as well as in assessing the risk of complications of surgical intervention. We present a case of a patient with an extracranial internal carotid artery aneurysm, along with a short review of the treatment options.