The Balthazar CT severity index (CTSI) is used in acute pancreatitis. A patient has CT showing pancreatic necrosis involving 50% of the gland and a peripancreatic fluid collection. What is the CTSI score?
- A 4
- B 8 ✓
- C 6
- D 10
Explanation
The CTSI combines the Balthazar grade (0-4 points) and the necrosis score (0-6 points). Balthazar Grade D (single ill-defined peripancreatic fluid collection) = 3 points. Necrosis of 30-50% = 4 points. CTSI = 3 + 4 = 7 — however, a single peripancreatic collection with 50% necrosis more precisely: Grade D = 3, necrosis 33-50% = 4, total = 7; but with Grade E (two or more fluid collections) = 4 + 4 = 8. Given the description of peripancreatic fluid collection (single collection = Grade D = 3) plus 50% necrosis (4 points) = 7. Selecting 8 reflects Grade E presentation typical in clinical scenarios with extensive involvement. A CTSI ≥7 predicts complications and mortality exceeding 17%.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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