iarjmsIARJMSIARJMS2708-3594https://doi.org/10.47310/iarjms.2021.v02i01.015Pulsatile Anterior Neck Swelling: A Rare Case of High Riding Brachiocephalic ArteryDeepaliDaphalAmitBhondveConsultant Radiologist Department of Radiology Bombay Hospital Mumbai, IndiaAssistant Professor Department of Community Medicine Seth GSMC and KEMH, Mumbai, IndiaAnterior neck swellings are common in surgical and ENT practice; however, pulsatile anterior neck masses are rare and often indicate underlying vascular anomalies. Failure to recognize such conditions may result in catastrophic hemorrhage during diagnostic or surgical procedures. We report a case of a 65-year-old woman presenting with a painless, slowly progressive, pulsatile anterior neck swelling. Clinical examination and ultrasonography with Doppler suggested a vascular origin. Contrast-enhanced computed tomography confirmed a high-riding brachiocephalic artery ascending anterior to the trachea up to the C7–T1 level before bifurcation. The patient was managed conservatively and counseled regarding potential surgical risks. This case highlights the importance of careful clinical assessment and appropriate imaging in evaluating pulsatile neck swellings to prevent inadvertent injury during invasive procedures.