Neonatal adrenal hemorrhage can usually be diagnosed on excretory urography without resorting to surgical exploration or invasive diagnostic procedures. In the typical case an avascular mass is seen between the liver and kidney. A case is presented in which a vascular rim surrounded the avascular mass, giving an appearance similar to that of an obstructed upper pole renal duplication. This early vascular rim, not as well known as the calcified rim which develops days to weeks after the acute hemorrhage, is probably created by compression and displacement of adrenal tissue by the central hemorrhage.
