Aneurysms of the popliteal vein represent a rare clinical finding. Most patients with popliteal venous aneurysms present with pulmonary emboli. We describe a case report of a 69-year-old female who presented with popliteal fossa pain. A popliteal venous aneurysm was detected following extensive diagnostic work-up that included magnetic resonance imaging (MRI), venous duplex, and venography. At operation, the aneurysm was found to be compressing the tibial nerve. Tangential aneurysmectomy and lateral venorrhaphy was performed. A PTFE sleeve was placed around the site of venous repair to prevent recurrence of the aneurysm and to keep the tibial nerve free of the repair site. The postoperative course was uneventful, and duplex studies at 18 months after the procedure remain normal. The etiology of popliteal venous aneurysms is discussed here, and presentation, diagnostic work-up, and treatment options are reviewed. We demonstrate that pain in the popliteal fossa should be considered a presenting symptom for venous aneurysms.