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A retrospective CT study was undertaken to evaluate nonneoplastic extragastric lesions associated with gastric wall thickening (GWT). A total of 70 cases was reviewed including 44 with acute pancreatitis. 6 with infected left upper quadrant fluid collections, and 20 with noninfected left upper quadrant fluid collections. Patients with acute pancreatitis and measurable gastric walls disclosed GWT in 67% of cases. All patients with infected left upper quadrant fluid collections (including abscesses and infected splenic hematomas) adjacent to the stomach exhibited GWT on computed tomography (CT). No patients with noninfected perigastric left upper quadrant fluid collections had GWT. Gastric wall thickening has been emphasized as an important feature in CT staging of gastric malignancies and has been noted in intrinsic gastric inflammatory disease. We conclude that extragastric inflammatory processes are commonly identified on CT and can be demonstrated to account for GWT. which appears to be a relatively sensitive and specific sign for distinguishing inflammatory from noninflammatory perigastric lesions.