Among the problems that confront the vascular surgeon, a pulsatile, right-sided neck mass requires a careful and logical evaluation. It has long been known that tortuosity of the right common carotid artery, frequently associated with advanced hypertension, can physically mimic a right carotid aneurysm. The question, then, is whether carotid angiography, with a higher attendant risk of morbidity and mortality, is preferable to less invasive diagnostic modalities such as computerized tomography (CT) and ultrasonography for initial evaluation. In our study, 31 consecutive patients with a pulsatile right neck mass, indistinguishable on physical examination from a carotid aneurysm, were evaluated using CT scan of the neck and either radionuclide scan or angiography. In all of the patients, the masses were confirmed to be tortuous right common carotid arteries and not aneurysms. Because a kinked carotid artery simulating an aneurysm occurs so frequently, noninvasive diagnostic techniques, such as CT and ultrasonography, should precede angiography. We also discuss demographic characteristics commonly associated with tortuosity of the right common carotid artery.