Balthazar score
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Balthazar score is used in CT severity index (CTSI) for grading of acute pancreatitis. CTSI includes grading of pancreatitis (A-E) and the extent of pancreatic necrosis.
CTSI
Grading of pancreatitis
- A: normal pancreas
-: 0 - B: enlargement of pancreas
-: 1 - C: inflammatory changes in pancreas and peripancreatic fat
-: 2 - D: ill defined single fluid collection
-: 3 - E: two or more poorly defined fluid collections
-: 4
Pancreatic necrosisÂ
- none
-: 0 - less than/equal to 30%
-: 2 - > 30-50 %
-: 4 - > 50%
-: 6
The maximum score that can be obtained is 10.
Stratification of pancreatitis severity
- mild pancreatitis (interstitial pancreatitis): Balthazar B or C , without pancreatic or extrapancreatic necrosis
- intermediate (exudative pancreatitis): Balthazar D or E, without pancreatic necrosis; peripancreatic collections are due to extrapancreatic necrosis
- severe pancreatitis (necrotising): with pancreatic necrosis
Necrosis of the pancreas, visualised best on contrast enhanced CT as non-enhancing areas, is considered to represent severe pancreatitis.
-<li>A: normal pancreas - 0</li>-<li>B: enlargement of pancreas - 1</li>-<li>C: inflammatory changes in pancreas and peripancreatic fat - 2</li>-<li>D: ill defined single fluid collection - 3</li>-<li>E: two or more poorly defined fluid collections - 4</li>- +<li>A: normal pancreas: 0</li>
- +<li>B: enlargement of pancreas: 1</li>
- +<li>C: inflammatory changes in pancreas and peripancreatic fat: 2</li>
- +<li>D: ill defined single fluid collection: 3</li>
- +<li>E: two or more poorly defined fluid collections: 4</li>
-<li>none - 0</li>-<li>less than/equal to 30% - 2</li>-<li>> 30-50 % - 4</li>-<li>> 50% - 6</li>- +<li>none: 0</li>
- +<li>less than/equal to 30%: 2</li>
- +<li>> 30-50 %: 4</li>
- +<li>> 50%: 6</li>
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Image 1 CT (C+ arterial phase) ( update )
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Case 1: Balthazar E
Image 2 CT (C+ portal venous phase) ( update )
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Case 2: Balthazar E
Image 3 CT (C+ portal venous phase) ( update )
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Case 3: Balthazar C
Image 4 CT (C+ portal venous phase) ( update )
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Case 4: Balthazar E
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