Bhalla Score

Stratifies bronchiectasis severity based on CT radiological findings in patients with cystic fibrosis.

Refer to the text below the score for details about its interpretation and the original study.


Bhalla score can be used in evaluating and monitoring pulmonary CT findings in patients with cystic fibrosis.

It can facilitate initial diagnosis and evaluation of disease progress and may be valuable in the preoperative evaluation of patients being considered for lobectomy or bullectomy and in the selection of patients for lung transplantation


Bhalla Score results range from 0 to 25, where the lower the score, the more severe the radiological bronchiectasis:

Bhalla score Interpretation
16 - 25 points Mild bronchiectasis
9 - 15 points Moderate bronchiectasis
0 - 8 points Severe bronchiectasis

1

Severity of bronchiectasis

2

Peribronchial thickening

3

No. of Bronchopulmonary segments involved

4

Extent of mucus plugging

5

Sacculations or abscesses

6

Generations of bronchial divisions involved

7

No. of bullae

8

No. of bullae

9

Collapse or consolidation

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Bhalla Score explained

The Bhalla score is a severity assessment for bronchiectasis based on several radiological findings that can be used in evaluating and monitoring patients with cystic fibrosis.

Item 0 1 2 3
Severity of bronchiectasis Absent Mild (lumen just > diameter of adjacent vessel) Moderate (lumen 2-3 times > diameter of adjacent vessel) Severe (lumen >3 times diameter of adjacent vessel)
Peribronchial thickening Absent Mild (wall thickness = diameter of adjacent vessel) Moderate (wall thickness ≤ 2 times diameter of adjacent vessel) Severe (wall thickness>2 times diameter of adjacent vessel)
Extent of bronchiectasis (no of lung segments) Absent 1 – 5 6 – 9 > 9
Extent of mucus plugs (no of lung segments) Absent 1 – 5 6 – 9 > 9
Abcesses or sacculations (no of lung segments) Absent 1 – 5 6 – 9 > 9
Generalities of the bronchial division involved (bronchiectasis/plug) Absent Up to 4th generation Up to 5th generation > 6th generation
No of bullae Absent Unilateral (not > 4) Bilateral (not > 4) > 4
Emphysema (no of lung segments) Absent 1 – 5 >5  
Collapse / consolidation Absent Subsegmental Segmental/lobar  

Bhalla scores range from 0 to 25, where the lower the score, the more severe the radiological bronchiectasis:

Bhalla score Disease severity
16 - 25 points Mild bronchiectasis
9 - 15 points Moderate bronchiectasis
0 - 8 points Severe bronchiectasis
 

About the original study and validation

The Bhalla score was developed in 1991 following an evaluation of computed tomography (CT) findings in patients with cystic fibrosis. A CT scoring system was devised that incorporates all of the changes seen in the lungs of patients with CF.

Further the score has been validated showing that CT assessment based on the Bhalla scoring system is more sensitive than pulmonary function tests in detecting initial morphologic changes.

A good correlation between Bhalla scores with spirometry confirmed its usefulness in evaluating and monitoring patients with cystic fibrosis.

 

References

Original reference

Bhalla M, Turcios N, Aponte V, Jenkins M, Leitman BS, McCauley DI, Naidich DP. Cystic fibrosis: scoring system with thin-section CT. Radiology. 1991; 179(3):783-8.

Validation

Cademartiri F, Luccichenti G, Palumbo AA, Maffei E, Pisi G, Zompatori M, Krestin GP. Predictive value of chest CT in patients with cystic fibrosis: a single-center 10-year experience. AJR Am J Roentgenol. Jun; 190(6):1475-80.

Other references

Pereira FF, Ibiapina Cda C, Alvim CG, Camargos PA, Figueiredo R, Pedrosa JF. Correlation between Bhalla score and spirometry in children and adolescents with cystic fibrosis. Rev Assoc Med Bras (1992). 2014; 60(3):216-21.


Specialty: Pulmonology

System: Respiratory

Objective: Stratification

Type: Score

No. Of Items: 9

Year Of Study: 1991

Article By: Denise Nedea

Published On: March 21, 2024 · 12:00 AM

Last Checked: March 21, 2024

Next Review: March 21, 2029