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Aneurysms of the carotid artery are known to be very rare. When they occur, they can result in upper airway obstruction, vascular embolisation of blood clots, stroke, or other neurologic deficits. Most importantly if they do rupture, it may be fatal. The present study reports a 24-year old male with a carotid artery aneurysm initially misdiagnosed as tuberculous adenitis that later developed dyspnoea, dysphagia and hoarseness. He was managed using a multidisciplinary approach. Intra-operative findings showed a huge pseudo-aneurysmal sac, 14 cm ×12 cm, completely occluding the airway and filled with blood and clots. The sac was communicating with the mid medial aspect of the common carotid artery via a 0.7 cm longitudinal tear. He had surgery and excision of the aneurysmal sac measuring 12 cm × 14 cm and recovered with neuropraxia of the right hypoglossal nerve which subsequently resolved.