A 44-year-old nonsmoking man with no significant past medical history was admitted for syncope of undetermined origin. No cardiac or neurologic finding was subsequently observed. Suspicion of epi-aortic vessel or thyroidal disease led to ultrasonography, which pointed out a hypo-echoic nodule at the right lower neck. A magnetic resonance image highlighted a 25 × 17 mm, well-defined, oval-shaped lesion, medially displacing the common carotid artery and laterally displacing the internal jugular vein, slightly compressed as far as its confluence with the anonymous vein; marked hyper-intensity and contrast-enhancement suggested hydric fat content (Fig 1A, T1-weighted, transversal section; 1B, T2-weighted contrast-enhanced coronal section; lesion indicated by arrows). Fine-needle aspiration biopsy was not diagnostic. A right cervicotomy parallel to the anterior border of the sternocleidomastoid muscle was carried out. After separate exposure of the carotid artery and jugular vein, continuity with the vagus nerve sheath was evident (Fig 2A). Careful intracapsular enucleation was performed preserving nerve integrity (Fig 2B, 2C [inset]). The patient had temporary dysphonia develop after the operation, although greatly recovered after phoniatric rehabilitation. Histopathology of the specimen confirmed the intraoperative diagnosis of schwannoma. No recurrence was noted after a 5-year period. Schwannomas are uncommon neoplasms, mainly benign [1Singer R.L. Thoracoscopic excision of a malignant schwannoma of the intrathoracic vagus nerve.Ann Thorac Surg. 1995; 59: 1586-1587Abstract Full Text PDF PubMed Scopus (18) Google Scholar]. The typical relationship with cervical vessels may be suggestive for vagal origin, although no diagnosis is generally available preoperatively. Surgical treatment is generally pursued, taking care to avoid nerve damage [2Walker W.A. Maguire F.E. Vagal schwannoma.Ann Thorac Surg. 1991; 52: 1370-1371Abstract Full Text PDF PubMed Scopus (4) Google Scholar, 3Heitmiller R.F. Labs J.D. Lipsett P.A. Vagal schwannoma.Ann Thorac Surg. 1990; 50: 811-813Abstract Full Text PDF PubMed Scopus (19) Google Scholar].