We report a case of adrenal hemorrhage in a newborn first detected by sonography at a menstrual age of 21 weeks 4 days. An echogenic mass was noted above the right kidney. The mass became larger and hypoechoic on follow‐up sonograms after birth. The mass was also seen on abdominal CT. Because it was difficult to differentiate the lesion from cystic neuroblastoma and because it shrank only modestly by 2 months after birth, we performed a surgical exploration when the patient was 2 months old, and adrenal hemorrhage was confirmed. This case suggests that adrenal hemorrhage can occur as early as the second trimester of pregnancy. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:206–209, 1999.