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We present a case of osteolytic lesions secondary to medullary fat necrosis associated with pancreatitis. The bone lesions are usually secondary to pancreatic trauma and evaluation of possible child abuse is indicated. The roentgenographic findings may not be seen until three to four weeks after the onset of pancreatic disease, and must be differentiated from osteomyelitis and traumatic periostitis. The presence of multiple lesions in many bones without substantial clinical signs of infection should suggest the pancreas as the primary problem.