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Anterior neck mass is a common symptom that is seen in otolaryngology surgery centers. Common types include thyroid tumor and thyroglossal duct cyst. In an elderly patient, a differentiated thyroid carcinoma should be suspected especially if it moves when swallowing. We encountered a typical presentation of a solitary thyroid nodule-like mass without pulsation in an 81-year-old female. We presented a rare diagnosis of pulsatile anterior neck swelling in which a high-riding subclavian artery should be considered as a differential diagnosis. Ultrasonography, Doppler scan, and contrast CT scan revealed that the neck mass corresponds to the high-riding subclavian artery. Therefore, ultrasonography is essential to detect any vascular lesion prior to biopsy or fine needle aspiration cytology as to avoid catastrophic hemorrhage.