import subprocess, json, base64
from io import BytesIO
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.oxml.ns import qn
from lxml import etree

# ── Colour palette (radiology/dark academic theme) ──────────────────────────
DARK_BG   = RGBColor(0x0D, 0x1B, 0x2A)   # deep navy
MID_BG    = RGBColor(0x1A, 0x2E, 0x44)   # mid navy
ACCENT    = RGBColor(0x00, 0xB4, 0xD8)   # cyan
ACCENT2   = RGBColor(0x90, 0xE0, 0xEF)   # light cyan
WHITE     = RGBColor(0xFF, 0xFF, 0xFF)
YELLOW    = RGBColor(0xFF, 0xD1, 0x66)
ORANGE    = RGBColor(0xFF, 0x85, 0x3A)
LIGHT_GRAY= RGBColor(0xCC, 0xD6, 0xE0)

W = Inches(13.333)
H = Inches(7.5)

prs = Presentation()
prs.slide_width  = W
prs.slide_height = H
blank = prs.slide_layouts[6]

# ── helpers ──────────────────────────────────────────────────────────────────

def bg(slide, color):
    """Fill slide background with solid colour."""
    background = slide.background
    fill = background.fill
    fill.solid()
    fill.fore_color.rgb = color

def rect(slide, x, y, w, h, color, alpha=None):
    shape = slide.shapes.add_shape(1, x, y, w, h)
    shape.fill.solid()
    shape.fill.fore_color.rgb = color
    shape.line.fill.background()
    return shape

def tb(slide, text, x, y, w, h,
       size=18, bold=False, color=WHITE, align=PP_ALIGN.LEFT,
       italic=False, wrap=True):
    box = slide.shapes.add_textbox(x, y, w, h)
    tf  = box.text_frame
    tf.word_wrap = wrap
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    p   = tf.paragraphs[0]
    p.alignment = align
    r   = p.add_run()
    r.text = text
    r.font.name   = "Calibri"
    r.font.size   = Pt(size)
    r.font.bold   = bold
    r.font.italic = italic
    r.font.color.rgb = color
    return box

def multi_para(slide, lines, x, y, w, h,
               size=16, bold=False, color=WHITE, bullet=True, spacing=1.15):
    """Add multiple bullet lines to one textbox."""
    box = slide.shapes.add_textbox(x, y, w, h)
    tf  = box.text_frame
    tf.word_wrap = True
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    for i, line in enumerate(lines):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.alignment = PP_ALIGN.LEFT
        p.space_after = Pt(4)
        r = p.add_run()
        r.text = ("• " if bullet else "") + line
        r.font.name   = "Calibri"
        r.font.size   = Pt(size)
        r.font.bold   = bold
        r.font.color.rgb = color
    return box

def heading_bar(slide, title, subtitle=None):
    """Coloured top bar with title."""
    rect(slide, 0, 0, W, Inches(1.1), MID_BG)
    rect(slide, 0, Inches(1.1), W, Inches(0.07), ACCENT)
    tb(slide, title, Inches(0.4), Inches(0.08), Inches(12), Inches(0.85),
       size=32, bold=True, color=ACCENT)
    if subtitle:
        tb(slide, subtitle, Inches(0.4), Inches(0.72), Inches(12), Inches(0.4),
           size=16, color=ACCENT2)

def add_image_from_url(slide, url, x, y, w, h):
    result = json.loads(subprocess.check_output(
        ["python", "/tmp/skills/shared/scripts/fetch_images.py", url]
    ))
    if result and result[0].get("base64"):
        raw = base64.b64decode(result[0]["base64"].split(",")[-1])
        slide.shapes.add_picture(BytesIO(raw), x, y, w, h)

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 1 — Title
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
rect(s, 0, 0, W, Inches(0.07), ACCENT)
rect(s, 0, Inches(7.43), W, Inches(0.07), ACCENT)
rect(s, 0, Inches(1.5), Inches(0.12), Inches(4.5), ACCENT)

tb(s, "PSEUDOANEURYSM", Inches(0.5), Inches(1.1), Inches(12), Inches(1.4),
   size=54, bold=True, color=ACCENT, align=PP_ALIGN.LEFT)
tb(s, "Radiology — Imaging, Diagnosis & Interventional Management",
   Inches(0.5), Inches(2.55), Inches(12), Inches(0.7),
   size=24, color=ACCENT2, align=PP_ALIGN.LEFT)
tb(s, "Comprehensive Radiological Review",
   Inches(0.5), Inches(3.35), Inches(9), Inches(0.5),
   size=18, color=LIGHT_GRAY, italic=True, align=PP_ALIGN.LEFT)

# right accent panel
rect(s, Inches(10.5), Inches(1.5), Inches(2.7), Inches(5.5), MID_BG)
for label, val in [("Modalities Covered", "US · CT · MRI · DSA"),
                   ("Locations", "Peripheral · Visceral · Aortic"),
                   ("Treatment", "Compression · Thrombin · Embolization · Stent")]:
    idx = [("Modalities Covered", "US · CT · MRI · DSA"),
           ("Locations", "Peripheral · Visceral · Aortic"),
           ("Treatment", "Compression · Thrombin · Embolization · Stent")].index((label,val))
    tb(s, label, Inches(10.65), Inches(1.75 + idx*1.55), Inches(2.5), Inches(0.4),
       size=11, color=YELLOW, bold=True)
    tb(s, val,   Inches(10.65), Inches(2.15 + idx*1.55), Inches(2.5), Inches(0.7),
       size=13, color=WHITE, wrap=True)

tb(s, "Sources: Grainger & Allison's Diagnostic Radiology · Textbook of Clinical Echocardiography · StatPearls · PMC 2023",
   Inches(0.5), Inches(6.9), Inches(10), Inches(0.5),
   size=10, color=LIGHT_GRAY, italic=True)

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 2 — Definition & Anatomy
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "Definition & Pathophysiology")

# Left column — definition
rect(s, Inches(0.3), Inches(1.35), Inches(6.1), Inches(5.8), MID_BG)
tb(s, "What is a Pseudoaneurysm?", Inches(0.5), Inches(1.45), Inches(5.7), Inches(0.5),
   size=20, bold=True, color=YELLOW)
multi_para(s, [
    "A pulsatile haematoma that communicates with the arterial lumen through a defect in the arterial wall",
    "LACKS all three layers of the true arterial wall (intima, media, adventitia)",
    "Contained by surrounding soft tissue, connective tissue, or haematoma",
    "Distinct from a TRUE aneurysm — which involves full-thickness dilation of all three walls",
], Inches(0.5), Inches(2.0), Inches(5.7), Inches(2.5), size=15, color=WHITE)

tb(s, "Key Structural Difference", Inches(0.5), Inches(4.55), Inches(5.7), Inches(0.4),
   size=16, bold=True, color=ACCENT)
multi_para(s, [
    "True Aneurysm: full-wall dilation — intima + media + adventitia all present",
    "Pseudoaneurysm: wall breach — contained only by perivascular tissue / clot",
    "Higher risk of rupture due to absent elastic wall support",
], Inches(0.5), Inches(5.0), Inches(5.7), Inches(1.8), size=14, color=LIGHT_GRAY)

# Right column — causes
rect(s, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.8), MID_BG)
tb(s, "Aetiology / Risk Factors", Inches(6.9), Inches(1.45), Inches(5.9), Inches(0.5),
   size=20, bold=True, color=YELLOW)

categories = [
    ("Iatrogenic (Most Common)", ["Arterial catheterisation (femoral, radial, brachial)", "Post-surgical anastomosis", "Percutaneous biopsy / nephrostomy", "Post-pancreatectomy haemorrhage"]),
    ("Traumatic", ["Penetrating trauma (stab, gunshot)", "Blunt abdominal trauma", "Renal trauma — more common in penetrating"]),
    ("Infectious / Mycotic", ["Bacterial endocarditis", "Septic emboli", "Post-pancreatic pseudocyst erosion"]),
    ("Spontaneous / Inflammatory", ["Pancreatitis eroding visceral arteries", "Tumour invasion", "Connective tissue disorders"]),
]
y_pos = 2.1
for cat, items in categories:
    tb(s, cat, Inches(6.9), Inches(y_pos), Inches(5.9), Inches(0.4),
       size=14, bold=True, color=ACCENT2)
    y_pos += 0.42
    for item in items:
        tb(s, "  • " + item, Inches(6.9), Inches(y_pos), Inches(5.9), Inches(0.35),
           size=12, color=WHITE)
        y_pos += 0.33
    y_pos += 0.1

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 3 — Clinical Features
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "Clinical Presentation")

boxes = [
    ("Superficial / Peripheral PSA", ACCENT, [
        "Painful, pulsatile mass",
        "Usually within 24 h of arterial access",
        "Bruit / thrill over the site",
        "Expanding haematoma",
        "Overlying skin erythema or bruising",
    ]),
    ("Visceral / Deep PSA", ORANGE, [
        "Abdominal or back pain",
        "GI bleeding (haemobilia, melaena)",
        "Obstructive jaundice (hepatic PSA)",
        "Haematuria (renal PSA)",
        "Haemodynamic instability if ruptured",
    ]),
    ("Aortic PSA", YELLOW, [
        "Chest / back pain",
        "Pulsatile abdominal mass",
        "Lower limb ischaemia",
        "Dysphagia / stridor if mediastinal",
        "Catastrophic bleeding on rupture",
    ]),
    ("Complications", RGBColor(0xFF,0x4D,0x4D), [
        "Rupture — most feared, potentially fatal",
        "Compression of adjacent structures",
        "Distal embolism / thrombosis",
        "Fistula formation (AV or visceral)",
        "Infection / sepsis",
    ]),
]

for i, (title, col, items) in enumerate(boxes):
    col_x = Inches(0.3 + i * 3.25)
    rect(s, col_x, Inches(1.3), Inches(3.1), Inches(5.9), MID_BG)
    rect(s, col_x, Inches(1.3), Inches(3.1), Inches(0.5), col)
    tb(s, title, col_x + Inches(0.1), Inches(1.33), Inches(2.9), Inches(0.45),
       size=13, bold=True, color=DARK_BG if col != RGBColor(0xFF,0x4D,0x4D) else WHITE, align=PP_ALIGN.CENTER)
    multi_para(s, items, col_x + Inches(0.12), Inches(1.9), Inches(2.85), Inches(5.0),
               size=13, color=WHITE)

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 4 — Ultrasound (B-mode + Doppler)
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "Ultrasound Imaging — B-mode & Colour Doppler")

rect(s, Inches(0.3), Inches(1.35), Inches(7.8), Inches(5.8), MID_BG)

tb(s, "B-mode Ultrasound", Inches(0.5), Inches(1.45), Inches(7.5), Inches(0.45),
   size=20, bold=True, color=ACCENT)
multi_para(s, [
    "Anechoic or hypoechoic rounded / oval collection adjacent to the artery",
    "May appear as an intra-renal or perivascular 'cyst'",
    "Swirling internal echoes visible (blood in motion = B-flow artefact)",
    "Partial thrombosis appears as hyperechoic material within the sac",
    "Narrow communicating neck connects sac to parent artery",
], Inches(0.5), Inches(1.95), Inches(7.5), Inches(2.2), size=14, color=WHITE)

tb(s, "Colour Doppler — Pathognomonic Signs", Inches(0.5), Inches(4.2), Inches(7.5), Inches(0.45),
   size=20, bold=True, color=ACCENT)

signs = [
    ("Yin-Yang Sign", "Turbulent swirling flow in the sac — alternating red/blue colour on CDI; bidirectional vortex"),
    ("To-and-Fro Sign", "Spectral Doppler at the neck: 'to' = forward flow (systole, into sac); 'fro' = reverse flow (diastole, out of sac)"),
    ("Arterialised Waveform", "High-resistance pulsatile signal at the neck distinguishes PSA from AVM/cyst"),
]
y = 4.72
for name, desc in signs:
    rect(s, Inches(0.5), Inches(y), Inches(2.1), Inches(0.75), ACCENT)
    tb(s, name, Inches(0.55), Inches(y+0.1), Inches(1.95), Inches(0.55),
       size=13, bold=True, color=DARK_BG, align=PP_ALIGN.CENTER)
    tb(s, desc, Inches(2.7), Inches(y+0.05), Inches(5.2), Inches(0.65),
       size=12, color=WHITE, wrap=True)
    y += 0.88

# Right — echo image (aortic PSA TEE)
tb(s, "TEE: Aortic Pseudoaneurysm", Inches(8.25), Inches(1.38), Inches(4.8), Inches(0.45),
   size=16, bold=True, color=ACCENT2, align=PP_ALIGN.CENTER)
add_image_from_url(s,
    "https://cdn.orris.care/cdss_images/bc9f2422dd421e8b303194b4cc8fe863448904f286733829dc2439e32da8b6dc.png",
    Inches(8.2), Inches(1.85), Inches(4.9), Inches(3.8))
tb(s, "TEE long-axis: disruption of posterior aortic sinus of Valsalva forming a PSA (long arrow) between Ao and LA. From: Textbook of Clinical Echocardiography.",
   Inches(8.2), Inches(5.7), Inches(4.9), Inches(1.2),
   size=10, color=LIGHT_GRAY, italic=True, wrap=True)

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 5 — CT Angiography
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "CT Angiography — The Imaging Modality of Choice")

# Left panel — text
rect(s, Inches(0.3), Inches(1.35), Inches(6.2), Inches(5.8), MID_BG)

tb(s, "Why CTA?", Inches(0.5), Inches(1.5), Inches(5.9), Inches(0.4),
   size=18, bold=True, color=YELLOW)
multi_para(s, [
    "Sensitivity ~90–95% and specificity ~98.7–100% for arterial injury",
    "Precisely defines PSA size, shape, neck, and feeding artery",
    "Characterises surrounding structures and non-vascular injuries",
    "Guides endovascular treatment planning",
], Inches(0.5), Inches(1.95), Inches(5.9), Inches(1.6), size=14, color=WHITE)

tb(s, "CT Phases & Findings", Inches(0.5), Inches(3.6), Inches(5.9), Inches(0.45),
   size=18, bold=True, color=ACCENT)

phases = [
    ("Non-contrast", "Low-attenuation rounded mass adjacent to artery; intermediate/high-density adjacent haematoma if ruptured; high attenuation within sac = thrombosis"),
    ("Arterial phase", "Contrast-filled sac = classic finding; pseudoaneurysm is rounded or oval and HIGH density (isodense to aorta); active extravasation = 'blush'"),
    ("Portal venous / delayed", "Sac becomes ISODENSE to surrounding tissue — differentiates from true active bleeding; partial thrombosis = residual low-attenuation zone"),
    ("Max. Intensity Projection", "MIP reconstructions best depict neck, feeding artery, and 3-D relationship to vital structures"),
]
y = 4.1
for phase, desc in phases:
    rect(s, Inches(0.5), Inches(y), Inches(1.6), Inches(0.7), ACCENT)
    tb(s, phase, Inches(0.55), Inches(y+0.05), Inches(1.5), Inches(0.6),
       size=11, bold=True, color=DARK_BG, align=PP_ALIGN.CENTER)
    tb(s, desc, Inches(2.2), Inches(y+0.03), Inches(4.1), Inches(0.66),
       size=11, color=WHITE, wrap=True)
    y += 0.79

# Right — CT image (renal PSA)
tb(s, "CT: Traumatic Renal Pseudoaneurysm", Inches(6.75), Inches(1.38), Inches(6.3), Inches(0.45),
   size=16, bold=True, color=ACCENT2, align=PP_ALIGN.CENTER)
add_image_from_url(s,
    "https://cdn.orris.care/cdss_images/4bd3fc14c7fddfe5b1ac9e6a54c8440ce1dd714c6eb7e8503254b9a2f4c139ab.png",
    Inches(6.7), Inches(1.85), Inches(6.35), Inches(3.6))
tb(s,
   "(A) Non-contrast: large perinephric haematoma (★). "
   "(B) Arterial phase: high-density pseudoaneurysm (arrow) — isodense to aorta. "
   "(C) Delayed phase: sac remains isodense. "
   "Source: Grainger & Allison's Diagnostic Radiology.",
   Inches(6.7), Inches(5.52), Inches(6.35), Inches(1.2),
   size=10, color=LIGHT_GRAY, italic=True, wrap=True)

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 6 — MRI & Conventional Angiography
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "MR Angiography & Conventional (Digital Subtraction) Angiography")

# MRA column
rect(s, Inches(0.3), Inches(1.35), Inches(6.1), Inches(5.8), MID_BG)
tb(s, "MR Angiography (MRA)", Inches(0.5), Inches(1.45), Inches(5.9), Inches(0.45),
   size=22, bold=True, color=ACCENT)

mra_points = [
    "3D gadolinium-enhanced MRA clearly demonstrates the PSA sac",
    "T1-weighted imaging: intraluminal thrombus appears hyperintense",
    "T2-weighted imaging: patent sac shows flow signal; thrombosed areas hypointense",
    "No ionising radiation — ideal for young patients, allergy to iodine, renal impairment",
    "LIMITATIONS: time-consuming; not suitable for acute/traumatic emergencies",
    "Claustrophobia limits use; metallic artefacts reduce quality",
    "Motion artefact is a concern in deep visceral PSA",
]
multi_para(s, mra_points, Inches(0.5), Inches(2.0), Inches(5.7), Inches(3.8), size=14, color=WHITE)

tb(s, "Indications for MRA over CTA", Inches(0.5), Inches(5.85), Inches(5.7), Inches(0.4),
   size=15, bold=True, color=YELLOW)
multi_para(s, [
    "Contrast allergy / chronic kidney disease",
    "Pregnancy (avoid radiation; gadolinium with caution in 2nd/3rd trimester)",
    "Follow-up of known PSA without need for immediate intervention",
], Inches(0.5), Inches(6.27), Inches(5.7), Inches(1.0), size=13, color=LIGHT_GRAY)

# DSA column
rect(s, Inches(6.7), Inches(1.35), Inches(6.3), Inches(5.8), MID_BG)
tb(s, "Conventional Angiography (DSA)", Inches(6.9), Inches(1.45), Inches(6.1), Inches(0.45),
   size=22, bold=True, color=ORANGE)

dsa_points = [
    "GOLD STANDARD — highest sensitivity and spatial resolution",
    "Detects PSA not visible on US, CT, or MRA",
    "Fully characterises: neck size/length, sac morphology, feeding artery, collaterals",
    "Essential for planning of embolisation, stent placement, or surgical ligation",
    "Allows simultaneous diagnosis AND endovascular treatment in one sitting",
]
multi_para(s, dsa_points, Inches(6.9), Inches(1.95), Inches(6.0), Inches(2.6), size=14, color=WHITE)

tb(s, "DSA Findings in PSA", Inches(6.9), Inches(4.6), Inches(6.0), Inches(0.45),
   size=16, bold=True, color=ACCENT)
multi_para(s, [
    "Opacification of sac communicating with donor artery via a narrow neck",
    "Delayed washout of contrast from the sac",
    "Associated AV fistula: early venous filling",
    "Active extravasation: contrast 'blush' outside sac = rupture",
], Inches(6.9), Inches(5.1), Inches(6.0), Inches(1.8), size=13, color=WHITE)

tb(s, "Limitations: Invasive; contrast and radiation use; risk of access-site complication; not first-line unless treatment planned.",
   Inches(6.9), Inches(6.8), Inches(6.1), Inches(0.55),
   size=11, color=LIGHT_GRAY, italic=True, wrap=True)

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 7 — Anatomical Locations
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "Anatomical Locations — Peripheral, Visceral & Aortic")

locs = [
    ("PERIPHERAL", ACCENT, [
        "Femoral (most common overall)",
        "  — Post-catheterisation / cardiac cath",
        "  — Duplex US: gold standard for diagnosis",
        "  — Sensitivity 100% (StatPearls 2024)",
        "Radial / brachial artery",
        "  — Increasing incidence with transradial PCI",
        "Popliteal artery",
        "  — Knee trauma or orthopaedic surgery",
        "Carotid artery",
        "  — Neck trauma / endarterectomy complication",
        "Peroneal / tibial arteries",
        "  — Peripheral vascular surgery",
    ]),
    ("VISCERAL", ORANGE, [
        "Splenic artery (most common visceral PSA)",
        "  — Pancreatitis, splenomegaly, trauma",
        "Hepatic artery",
        "  — Liver biopsy, biliary procedures, trauma",
        "  — Haemobilia triad: pain, jaundice, GI bleed",
        "Renal artery",
        "  — Penetrating > blunt trauma",
        "  — Post-biopsy, nephrostomy",
        "Gastroduodenal / pancreaticoduodenal arteries",
        "  — Pancreatitis (enzyme erosion)",
        "Superior mesenteric artery branches",
        "  — Inflammatory bowel, surgery, trauma",
    ]),
    ("AORTIC / CARDIAC", YELLOW, [
        "Post-surgical aortic PSA",
        "  — Proximal/distal graft anastomoses",
        "  — Coronary reimplantation sites",
        "Aortic valve / root surgery",
        "  — Root-enlarging procedures",
        "  — Endocarditis with tissue destruction",
        "Echocardiographic appearance:",
        "  — Echolucent area adjacent to graft",
        "  — Color flow: filling of extra-cardiac space",
        "  — TEE > TTE for image quality",
        "Post-traumatic aortic PSA",
        "  — Isthmus: deceleration injury (MVC)",
    ]),
]

for i, (title, col, items) in enumerate(locs):
    x = Inches(0.3 + i * 4.33)
    rect(s, x, Inches(1.3), Inches(4.1), Inches(5.95), MID_BG)
    rect(s, x, Inches(1.3), Inches(4.1), Inches(0.5), col)
    tb(s, title, x + Inches(0.1), Inches(1.33), Inches(3.9), Inches(0.45),
       size=16, bold=True, color=DARK_BG, align=PP_ALIGN.CENTER)
    y = 1.88
    for item in items:
        indent = item.startswith("  —")
        tb(s, item.strip(), x + Inches(0.15 + (0.2 if indent else 0.0)),
           Inches(y), Inches(3.7), Inches(0.37),
           size=11 if indent else 12,
           color=LIGHT_GRAY if indent else WHITE,
           bold=not indent)
        y += 0.37

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 8 — Differential Diagnosis
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "Differential Diagnosis — Imaging Pitfalls & Key Differentiators")

# Table header
headers = ["Entity", "US Appearance", "CT Appearance", "Key Differentiator"]
col_widths = [Inches(2.4), Inches(3.0), Inches(3.2), Inches(4.3)]
col_x = [Inches(0.25), Inches(2.7), Inches(5.75), Inches(9.0)]
y_row = 1.35

for i, (hdr, cx, cw) in enumerate(zip(headers, col_x, col_widths)):
    rect(s, cx, Inches(y_row), cw, Inches(0.55), ACCENT)
    tb(s, hdr, cx + Inches(0.05), Inches(y_row + 0.05), cw - Inches(0.1), Inches(0.45),
       size=14, bold=True, color=DARK_BG, align=PP_ALIGN.CENTER)

rows = [
    ("True Aneurysm", "Fusiform/saccular dilation; all 3 layers visible", "Fusiform/saccular enhancement; normal wall layers", "No history of trauma/procedure; full-wall dilation on imaging"),
    ("Haematoma", "Non-compressible heterogeneous mass; no flow on CDI", "Non-enhancing collection; variable density", "Absent vascular communication on Doppler / post-contrast CT"),
    ("AV Fistula", "Turbulent arterialised venous flow; no sac", "Early venous enhancement from arterial phase", "No discrete sac; persistent forward (not to-and-fro) flow"),
    ("Abscess / Cyst", "Hypoechoic/anechoic; internal debris; no flow", "Rim-enhancing collection; non-vascular", "No Doppler signal; no connection to artery; clinical infection"),
    ("Lymph Node / Tumour", "Hypoechoic; vascularity may be present", "Enhancing mass; no arterial communication", "No neck; characteristic lymph node morphology; biopsy"),
    ("Arterial Dissection", "Double-lumen; intimal flap on B-mode", "Two lumens; intimal flap; no sac", "True + false lumen; no sac; different flow dynamics"),
]
row_colors = [DARK_BG, MID_BG, DARK_BG, MID_BG, DARK_BG, MID_BG]
y_row = 1.9
row_h = 0.82

for row_i, (row, bg_col) in enumerate(zip(rows, row_colors)):
    for ci, (cell, cx, cw) in enumerate(zip(row, col_x, col_widths)):
        rect(s, cx, Inches(y_row), cw, Inches(row_h), bg_col)
        tb(s, cell, cx + Inches(0.07), Inches(y_row + 0.05), cw - Inches(0.1), Inches(row_h - 0.1),
           size=11, color=WHITE if ci > 0 else ACCENT2, bold=(ci==0), wrap=True)
    y_row += row_h

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 9 — Treatment Options
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "Treatment — From Conservative to Endovascular & Surgical")

options = [
    ("Observation / Conservative", ACCENT, [
        "Small PSA (<2 cm), especially post-biopsy",
        "High spontaneous thrombosis rate in small PSAs",
        "Serial US surveillance every 4–6 weeks",
        "Anticoagulated patients: higher failure rate",
    ]),
    ("US-Guided Compression", RGBColor(0x00, 0x96, 0x88), [
        "External compression of PSA neck with US probe",
        "Target: thrombosis of sac while preserving artery patency",
        "Success 63–88%; painful for patient",
        "Failure in deep/large PSA or anticoagulated patients",
    ]),
    ("Thrombin Injection (UGTI)", ORANGE, [
        "US-guided injection of thrombin into sac (NOT the neck)",
        "Converts fibrinogen → fibrin → thrombosis of sac",
        "Success rate near 97% in non-infected PSA",
        "Risk: distal thromboembolism if thrombin enters artery",
        "Contraindicated: infected PSA, wide neck (>1 cm)",
    ]),
    ("Endovascular — Embolisation", YELLOW, [
        "IR coil / glue / plug embolisation of feeding artery",
        "Visceral PSA (splenic, hepatic, renal, GDA): ~100% success",
        "Approaches: selective parent artery, neck packing, sac fill",
        "CT angiography guides catheter selection",
    ]),
    ("Endovascular — Covered Stent", RGBColor(0xE0, 0x60, 0x20), [
        "Stent-graft deployed across PSA neck",
        "Excludes sac while maintaining parent artery flow",
        "Ideal for large-vessel PSA (femoral, iliac, aortic)",
        "Requires adequate proximal/distal landing zones",
    ]),
    ("Surgery", RGBColor(0xFF, 0x4D, 0x4D), [
        "Open repair: excision + direct suture / patch",
        "Bypass grafting if vessel sacrifice needed",
        "Indicated: failed endovascular, infected anastomotic PSA",
        "Post-cardiac surgery: urgent repair to prevent mediastinal rupture",
    ]),
]

ncols = 3
nrows = 2
box_w = Inches(4.1)
box_h = Inches(2.55)
gutter_x = Inches(0.32)
gutter_y = Inches(0.25)
start_x = Inches(0.25)
start_y = Inches(1.35)

for idx, (title, col, items) in enumerate(options):
    row = idx // ncols
    ci  = idx %  ncols
    bx = start_x + ci * (box_w + gutter_x)
    by = start_y + row * (box_h + gutter_y)
    rect(s, bx, by, box_w, box_h, MID_BG)
    rect(s, bx, by, box_w, Inches(0.45), col)
    tb(s, title, bx + Inches(0.08), by + Inches(0.03),
       box_w - Inches(0.1), Inches(0.4),
       size=13, bold=True, color=DARK_BG, align=PP_ALIGN.CENTER)
    multi_para(s, items, bx + Inches(0.1), by + Inches(0.5),
               box_w - Inches(0.15), box_h - Inches(0.6),
               size=12, color=WHITE)

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 10 — Imaging Protocol Summary & Pearls
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "Imaging Protocol Summary & Radiological Pearls")

# Protocol table
rect(s, Inches(0.3), Inches(1.35), Inches(8.0), Inches(5.9), MID_BG)
tb(s, "Recommended Imaging Protocol by Location", Inches(0.5), Inches(1.45), Inches(7.7), Inches(0.45),
   size=18, bold=True, color=ACCENT)

protocol_rows = [
    ("Femoral / Peripheral", "Duplex US (first-line)", "CTA if complex / pre-op", "Not routine"),
    ("Visceral (hepatic/splenic/renal)", "US + CDI (initial screen)", "CTA with arterial + portal phases", "DSA if endovascular Rx planned"),
    ("Post-pancreatectomy haemorrhage", "CTA immediately", "CTA → DSA/embolisation", "MRA not appropriate (urgent)"),
    ("Aortic / post-cardiac surgery", "TTE / TEE", "CTA chest with ECG-gating", "DSA for repair planning"),
    ("Traumatic renal", "FAST US (initial)", "Multiphase MDCT incl. delayed", "DSA if active bleeding"),
]

hdr_cols = ["Location", "First-Line", "Second-Line", "Adjunct"]
hdr_widths = [Inches(2.2), Inches(1.8), Inches(2.0), Inches(2.0)]
hdr_x_vals = [Inches(0.35), Inches(2.6), Inches(4.45), Inches(6.5)]

y_tbl = 2.0
for hx, hw, hd in zip(hdr_x_vals, hdr_widths, hdr_cols):
    rect(s, hx, Inches(y_tbl), hw, Inches(0.45), ACCENT)
    tb(s, hd, hx+Inches(0.05), Inches(y_tbl+0.05), hw-Inches(0.05), Inches(0.35),
       size=12, bold=True, color=DARK_BG, align=PP_ALIGN.CENTER)
y_tbl += 0.46

for ri, row in enumerate(protocol_rows):
    row_bg = DARK_BG if ri % 2 == 0 else RGBColor(0x15, 0x28, 0x3E)
    for cell, hx, hw in zip(row, hdr_x_vals, hdr_widths):
        rect(s, hx, Inches(y_tbl), hw, Inches(0.88), row_bg)
        tb(s, cell, hx+Inches(0.07), Inches(y_tbl+0.04), hw-Inches(0.1), Inches(0.8),
           size=11, color=WHITE if hdr_x_vals.index(hx)>0 else ACCENT2,
           bold=(hdr_x_vals.index(hx)==0), wrap=True)
    y_tbl += 0.88

# Pearls column
rect(s, Inches(8.55), Inches(1.35), Inches(4.5), Inches(5.9), MID_BG)
tb(s, "⚡ Key Radiological Pearls", Inches(8.7), Inches(1.45), Inches(4.2), Inches(0.45),
   size=18, bold=True, color=YELLOW)

pearls = [
    ("To-and-Fro = Pathognomonic", "Spectral Doppler at the neck is diagnostic; absent in cysts/haematomas"),
    ("Wash-in/Wash-out on CT", "Arterial high density → portal venous isodensity distinguishes PSA from active bleed"),
    ("Neck Width Matters", "Narrow neck (<5 mm): thrombin injection safe; Wide neck: prefer stent-graft"),
    ("Multiphase MDCT", "Non-contrast + arterial + portal venous phases mandatory for complete characterisation"),
    ("CTA = treatment roadmap", "Defines anatomy for embolisation route; predicts need for collateral preservation"),
    ("Missed PSA risk", "Delayed presentation (days to weeks post-trauma/procedure) — always consider when haematuria or pulsatile mass develops late"),
]
y_p = 2.0
for title, desc in pearls:
    rect(s, Inches(8.7), Inches(y_p), Inches(0.12), Inches(0.6), ACCENT)
    tb(s, title, Inches(8.9), Inches(y_p), Inches(3.9), Inches(0.35),
       size=13, bold=True, color=ACCENT2)
    tb(s, desc, Inches(8.9), Inches(y_p+0.35), Inches(3.9), Inches(0.5),
       size=11, color=WHITE, wrap=True)
    y_p += 0.9

# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 11 — Summary & References
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
bg(s, DARK_BG)
heading_bar(s, "Summary")

rect(s, 0, Inches(7.43), W, Inches(0.07), ACCENT)

summary_points = [
    "Pseudoaneurysm = pulsatile haematoma communicating with an artery, contained by perivascular tissue (NOT true arterial wall)",
    "Most common aetiology: iatrogenic (post-catheterisation femoral artery)",
    "US with CDI: first-line for superficial PSA — pathognomonic yin-yang sign + to-and-fro Doppler waveform at the neck",
    "CTA: modality of choice for deep/visceral/aortic PSA — arterial-phase high density → delayed-phase isodensity",
    "DSA: gold standard; simultaneously enables endovascular treatment (embolisation, stent-graft)",
    "MRA: radiation-free alternative for contrast allergy / renal impairment; not suitable in acute settings",
    "Treatment ladder: observation → compression → thrombin injection (UGTI) → embolisation → stent-graft → surgery",
    "Rupture is the most feared complication — early diagnosis and treatment are essential",
]

rect(s, Inches(0.3), Inches(1.35), Inches(12.7), Inches(5.1), MID_BG)
multi_para(s, summary_points, Inches(0.55), Inches(1.5), Inches(12.2), Inches(4.8),
           size=15, color=WHITE)

# References
rect(s, Inches(0.3), Inches(6.55), Inches(12.7), Inches(0.85), RGBColor(0x10, 0x22, 0x32))
refs = ("References: Grainger & Allison's Diagnostic Radiology (9780323760751) · "
        "Textbook of Clinical Echocardiography (9780323882088) · "
        "StatPearls: Pseudoaneurysm (NCBI) · "
        "PMC10716566: Pseudoaneurysms — ultrasound patterns (2023) · "
        "PMC6798774: Interventional treatment options in pseudoaneurysms (2019) · "
        "Radiología 67:202–213 (2025): Imaging of pseudoaneurysms")
tb(s, refs, Inches(0.5), Inches(6.62), Inches(12.3), Inches(0.72),
   size=9, color=LIGHT_GRAY, italic=True, wrap=True)

# ═══════════════════════════════════════════════════════════════════════════════
# SAVE
# ═══════════════════════════════════════════════════════════════════════════════
out = "/tmp/workspace/pseudoaneurysm-ppt/Pseudoaneurysm_Radiology.pptx"
buf = BytesIO()
prs.save(buf)
with open(out, "wb") as f:
    f.write(buf.getvalue())
print(f"Saved: {out}")
print(f"Slides: {len(prs.slides)}")

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/pseudoaneurysm-ppt/build_ppt.py'