Long lasting sialolithiasis can cause structural and functional changes of the salivary glands, inflammatory infiltration and fibrosis. However fat infiltration with sialolithiasis has not been described in the parotid glands. We describe a 60 years old man, bus-driver who presented with a history of reccurent right parotid sialadenitis and was diagnosed to have bilateral sialolithiasis and left parotid fat infiltration. Imaging showed large intraparenchymal stones in both parotid glands. Gland atrophy with homogeneous fat distribution and severe hypofunction were the main imaging findings on the left side. The right parotid gland had normal findings in imaging studies. In conclusion, we suggest that sialolithiasis caused chronic obstruction, due to increased ductal pressure, sialadenitis, fat infiltration, hypofunction and atrophy on the left parotid gland. Patient denied further treatment.