Vascular leiomyomas are composed of smooth muscle cells and vascular endothelium. They are rarely seen in the head and neck region. A 32-year-old woman presented with a slowly-growing pulsatile mass in the right upper jugular region. Angiography showed a mass in the carotid bifurcation. It was not extensively vascularized, but displaced the internal and external carotid arteries. After neck exploration, the lesion was totally resected without any complications. Histopathologic diagnosis was vascular leiomyoma. No recurrence was detected during a two-year follow-up.