Although isolated iliac artery aneurysms are rare and occur in only 2% of patients, isolated internal iliac artery aneurysms are even more uncommon. Patients with these aneurysms require urgent vascular surgery consultation and evaluation; untreated aneurysms have a high propensity to increase in size and rupture. Providers should be aware of this critical incidental finding on CT scan and MRI and know when to initiate an emergency workup and therapy.