Balthazar score

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.


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 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 on contrast enhanced CT as non-enhancing areas, is considered to represent severe pancreatitis.

Pancreatic pathology

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