Mycotic aneurysms of the extracranial carotid artery are very uncommon, with only twenty-nine cases reported in the medical literature. This is a report of a mycotic aneurysm of the common carotid artery caused by septic cervical lymphadenopathy. A review of the literature is presented in an attempt to elucidate which surgical approach is superior, ligation or repair of the carotid artery.