The acute scrotum in a neonatal patients is an emergency. Its'etiology is variable, mostly represented by testicular torsion, trauma or adrenal hemorrhage. Previously, immediate scrotal exploration was considered imperative for diagnosis and treatment. With good imaging studies, some patients are conservatively managed. We report two cases of neonatal adrenal hemorrhage presenting as acute scrotum misguiding the clinician to rule out a local scrotal pathology. As the clinical examination is not reliable in a new-born, it definitely requires an imaging evaluation to establish the diagnosis. This case report tries to outline the importance of the correlation between acute adrenal hemorrhage and acute scrotum and the role of ultrasonography as a useful tool for differential diagnosis. A well performed ultrasound examination helps to identify an abdominal pathology as the cause of an acute scrotum and to specifically diagnose an adrenal hemorrhage in order to avoid unnecessary surgical exploration.