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Background Although exceedingly uncommon, iliac artery pseudoaneurysms might complicate trauma, surgical, or interventional operations. Aim We are presenting this case to emphasize how vital it is to rule out vascular lesions as a possible diagnosis when patients arrive with mass or pressure feelings in various body areas. Result Report of a 29-year-old man with a painful right lower abdomen pulsatile mass that turned out to be a pseudo aneurysm originating from the right common iliac artery, which was verified by contrast-enhanced CT and CT angiography. A large aneurysm connected to a fistula between the right common iliac artery and vein was discovered after open surgery where aneurysmal sac excised and PTFE interposition graft was used to reconstruct the artery and on follow up patient pass smoothly. Conclusion Serious implications might follow from misdiagnosing these lesions as soft tissue tumors or abscesses so it is paramount to put arterial lesion in differential diagnosis. [ABSTRACT FROM AUTHOR]