A 10-year-old boy with testicular adrenal rest tumors (ART) and congenital adrenal hyperplasia (CAH) is presented. He suffered from precocious virilization and bilateral testicular enlargement since 8 years of age. Ultrasound examination of the scrotum revealed multiple hypoechoic areas over bilateral testicles representing focal nodules. Incisional biopsy and the subsequent histopathological examination confirmed bilateral ART.