Painful ulnar artery leiomyoma simulating an ulnar artery aneurysm

Angioleiomyomas are rare, benign, smooth muscle tumors that occur predominantly in the lower limbs and infrequently in the upper limbs. We present a case of angioleiomyoma arising from the distal ulnar artery, presenting as a painful lesion with a 20-year history of diagnostic uncertainty. It was preoperatively misdiagnosed as an ulnar artery aneurysm. Surgical excision with primary end-to-end arterial repair was performed. Histopathological examination confirmed features consistent with a leiomyoma arising from the distal ulnar artery wall. The patient became asymptomatic following the surgery and remains pain-free at 6 months of follow-up.