Pediatr Radiol (1981) 10:175-177 Pediatric Radiology 9 Springer-Verlag 1981 Pancreatitis, Child Abuse, and Skeletal Lesions H. Cohen, J. O. Haller and Anita P. Friedman Department of Radiology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA Abstract. A case of pancreatitis associated with trauma of child abuse is reported. Skeletal changes secondary to pancreatitis developed and the distribu- tion of the bony lesions included both metaphyseal and epiphyseal growth centers. The coexistence of pancreatitis, child abuse, and subsequent skeletal lesions is again emphasized, as well as the unique occurrence of lesions in the epiphyseal centers. Key words: Acute pancreatitis - Blunt trauma - Child abuse - Osteolysis - Pancreatic bone lesions examination revealed a slightly distended tympanitic abdomen without definite guarding or rigidity. Bowel sounds were diminished. Laboratory values were normal except for a hemato- crit of 34% and Wbc of 23.000. He was diagnosed as having an acute abdomen, possibly secondary to trauma or acute appen- dicitis. Laparotomy revealed some bloodstained fluid in the ab- domen, retroperitoneal and peripancreatic hematoma, and hematoma of the walls of the ascending and transverse colon. The surgical diagnosis was battered child with intraabdominal trauma. In children, acute pancreatitis resulting from blunt trauma has become increasingly noted since Hart- ley's report of three cases in 1967 [1]. It has subsequently been shown that pancreatitis can result from child abuse and can lead to associated bony lesions [3, 5]. Theorized to be secondary to resultant in- tramedullary fat necrosis [2], these lesions have been thought to involve "all tubular bones with sparing of the epiphyses" [5]. In our patient we observed that the post pancreatic development of bony lesions occurred in the epiphyses, diaphyses and metaphyses. Case Report A 3 year old black male was seen in the emergency room with the chief complaint of abdominal pain and lethargy. His mother had stated that one day prior to admission he was found on the floor, apparently having fallen. One to two hours later he complained of abdominal pain and nausea. After a restless night he was noted to be somnolent but responsive. On admission he was noted to be acutely ill, dehydrated and drowsy. Vital signs included: temperature 96 ~ respiratory rate 66/minute, pulse 146/minute and blood pressure 80/50. Physical Fig. L A P knees. Both right and left femurs and tibias show well defined, well marginated lucencies in the metaphyses of all bones 0301-0449/81/0010/0175/$01.50