Neonatal adrenal hemorrhage is a rare phenomenon which may occur in utero or in the intrapartum period. This case illustrates ultrasound and subsequent abdominal computed tomography (CT) imaging of a 30-day-old neonate who initially presented with acute vomiting and was found to have an abscess at the site of a previous right-sided adrenal hemorrhage. Ultrasound-guided fine needle aspiration of the abscess was ultimately the key diagnostic and therapeutic intervention, which detected Escherichia coli (E. coli) infection. The discussion addresses the connection between key pathologic features of this case, while reviewing the acute management of clinical sequelae in the emergency department.