Fat necrosis in association with pancreatic disease is usually limited to the pancreas and adjacent tissues. In some instances, however, widely disseminated fat necrosis occurs and "metastatic" foci may be observed in the mediastinum, pericardium, and subpleural tissues,1 subcutaneous tissues,2 periarticular tissues,3 and bone marrow.4 Scarpelli4 demonstrated foci of fat necrosis in the bone marrow in 7 of 67 autopsied cases of acute hemorrhagic pancreatitis and in two of six dogs dying in experimentally induced hemorrhagic pancreatitis. In all cases, medullary fat necrosis occurred in association with widespread abdominal or extraabdominal fat necrosis.
Metastatic fat necrosis has also been described in patients with carcinoma of the pancreas,5 chronic pancreatitis,6 and traumatic pancreatitis.5,7,8 See also the article by Neuer et al in this issue (p 738). In children, trauma to the abdomen is the most common cause of acute pancreatitis.9 Medullary fat
SHACKELFORD PG. Osseous Lesions and Pancreatitis. Am J Dis Child. 1977;131(7):731-732. doi:10.1001/archpedi.1977.02120200013002