Balthazar score

The Balthazar score is used ina subscore within the CT severity index (CTSI) for grading of acute pancreatitis.

The CTSI includessums two scores:

• Balthazar score: grading of pancreatitis (A-E) and
• grading the extent of pancreatic necrosis

The Balthazar score was originally used alone, but the addition of a score for pancreatic necrosis improved correlation with clinical severity scores.

The CTSI has since been updated to the modified CTSI (2004).

CTSI

Grading of pancreatitis (Balthazar score)

• A: normal pancreas: 0
• B: enlargement of pancreas: 1
• C: inflammatory changes in pancreas and peripancreatic fat: 2
• D: ill defined single peripancreatic fluid collection: 3
• E: two or more poorly defined peripancreatic fluid collections: 4

Pancreatic necrosis 

• 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 (non-enhancing areas in the pancreas on contrast enhanced-enhanced CT)

Treatment and prognosis

There is good correlation of clinical pancreatitis scores and current