BASE="/tmp/workspace/attachments/dcf7284f-a24f-414d-8779-2928cbf819ff" files=( "MUJEEB KHAN.MR 66Y_M_IP2605170677_26.docx" "RAMANJANEYA.MR 68Y_M_IP_260245440142_.docx" "ANNAPOORNAMMA.MRS 58Y_F_OP_2605120005_26.docx" "MAHALINGAPPA.MR 35Y_F_IP_2605000133_26.docx" "CHIKKAMMA.MRS 45Y_F_op_2605120155_26.docx" "BASAVARAJU.MR 50Y_M_IP_R260710100_26 (1).docx" "CHKKARNGAIAH.MR 88Y_M_IP_2603090146_26.docx" "NARASIMHAMURTHY.MR_OP__2605110882_26.docx" "PUTTARAJU.MR 74Y_M_IP_2603100148_26.docx" ) for f in "${files[@]}"; do echo "==============================" echo "FILE: $f" echo "==============================" python3 -c " from docx import Document doc = Document('$BASE/$f') for p in doc.paragraphs: if p.text.strip(): print(p.text) # Also read tables for table in doc.tables: for row in table.rows: for cell in row.cells: if cell.text.strip(): print(cell.text) " 2>&1 echo "" done

# Try reading the .doc file with antiword or python-docx fallback BASE="/tmp/workspace/attachments/dcf7284f-a24f-414d-8779-2928cbf819ff" FILE="Sunandamma ct neck 23-04-25.doc" # Try python-docx first (may fail on .doc) python3 -c " from docx import Document doc = Document('$BASE/$FILE') for p in doc.paragraphs: if p.text.strip(): print(p.text) " 2>&1 || echo "python-docx failed" # Try reading raw text from binary .doc strings "$BASE/$FILE" | grep -A 2 -E "[A-Z]{3,}|[0-9]x[0-9]|mm|cm|lesion|tumor|mass|lymph|enhancing|hypodense|calcif" | head -200

mkdir -p /tmp/workspace/radiology-exam-cases

cat << 'PYEOF' > /tmp/workspace/radiology-exam-cases/generate_cases.py from docx import Document from docx.shared import Pt, RGBColor, Inches from docx.enum.text import WD_ALIGN_PARAGRAPH from docx.oxml.ns import qn from docx.oxml import OxmlElement doc = Document() # ---- Styles ---- style = doc.styles['Normal'] style.font.name = 'Arial' style.font.size = Pt(11) # Page margins section = doc.sections[0] section.top_margin = Inches(0.8) section.bottom_margin = Inches(0.8) section.left_margin = Inches(1.0) section.right_margin = Inches(1.0) def add_title(doc, text): p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.add_run(text) run.bold = True run.font.size = Pt(16) run.font.color.rgb = RGBColor(0x1F, 0x35, 0x64) def add_case_header(doc, case_no, name, age_sex, modality, date): p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.LEFT run = p.add_run(f"CASE {case_no}: {modality}") run.bold = True run.font.size = Pt(13) run.font.color.rgb = RGBColor(0xC0, 0x00, 0x00) # Patient info table table = doc.add_table(rows=1, cols=4) table.style = 'Table Grid' cells = table.rows[0].cells cells[0].text = f"Name: {name}" cells[1].text = f"Age/Sex: {age_sex}" cells[2].text = f"Date: {date}" cells[3].text = "" for cell in cells: for para in cell.paragraphs: for run in para.runs: run.bold = True run.font.size = Pt(10) def add_section(doc, heading, content_lines): p = doc.add_paragraph() run = p.add_run(f"► {heading}") run.bold = True run.font.size = Pt(11) run.font.color.rgb = RGBColor(0x1F, 0x35, 0x64) for line in content_lines: if line.strip(): bp = doc.add_paragraph(style='List Bullet') bp.text = line.strip("- •") bp.paragraph_format.left_indent = Inches(0.3) for run in bp.runs: run.font.size = Pt(10) def add_qa_section(doc, qas): p = doc.add_paragraph() run = p.add_run("► VIVA / EXAM QUESTIONS & ANSWERS") run.bold = True run.font.size = Pt(11) run.font.color.rgb = RGBColor(0x1F, 0x35, 0x64) for i, (q, a) in enumerate(qas, 1): qp = doc.add_paragraph() qr = qp.add_run(f"Q{i}. {q}") qr.bold = True qr.font.size = Pt(10) ap = doc.add_paragraph() ar = ap.add_run(f"A: {a}") ar.italic = True ar.font.size = Pt(10) ap.paragraph_format.left_indent = Inches(0.3) def add_divider(doc): doc.add_paragraph("─" * 90) def add_key_teaching(doc, points): p = doc.add_paragraph() run = p.add_run("► KEY TEACHING POINTS") run.bold = True run.font.size = Pt(11) run.font.color.rgb = RGBColor(0x37, 0x5A, 0x22) for pt in points: bp = doc.add_paragraph(style='List Bullet') bp.text = pt bp.paragraph_format.left_indent = Inches(0.3) for run in bp.runs: run.font.size = Pt(10) # ======================================================== # TITLE PAGE # ======================================================== doc.add_paragraph() add_title(doc, "RADIOLOGY PRACTICAL EXAM — CASE PREPARATION") p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER p.add_run("Sri Siddhartha Medical College Hospital | Department of Radiodiagnosis & Imaging").italic = True p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER p.add_run("Prepared by: R3 Radiology Resident | July 2026").italic = True doc.add_paragraph() add_divider(doc) doc.add_page_break() # ======================================================== # CASE 1: MUJEEB KHAN — CECT THORAX # ======================================================== add_case_header(doc, "01", "Mujeeb Khan", "66Y / M", "CECT THORAX", "23-May-2026") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "66-year-old male with left-sided pleural disease; ICD tube in situ", "Presented for evaluation of pulmonary/pleural pathology", ]) add_section(doc, "KEY IMAGING FINDINGS", [ "Well-defined round heterogeneously enhancing mass (3.1 × 3.3 × 3.3 cm) in apicoposterior segment of LEFT UPPER LOBE", "Spiculated margins — hallmark of malignancy", "Abutting the oblique fissure with focal fissural thickening", "Multiple pleural-based soft tissue thickenings (apical, medial, costal pleura, left side) — pleural metastases", "Retrosternal fat pad: enhancing soft tissue deposits + enlarged lymph nodes", "Right upper lobe: small nodule with parenchymal band + fibrocalcific opacity (apical segment)", "Right adrenal gland: bulky with post-contrast enhancement — adrenal metastasis", "ICD tube: left D8-D9 intercostal space, tip toward left diaphragmatic region", "Vertebrae: diffuse osteopenic changes + degenerative changes; no focal lytic/sclerotic lesion", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "PRIMARY DIAGNOSIS: Bronchogenic carcinoma (left upper lobe) with secondary pleural deposits", "Mediastinal + retrosternal nodal metastases", "Likely right adrenal metastasis", "Stage: Advanced (likely Stage IV) — PET-CT + HPE recommended", ]) add_section(doc, "DIFFERENTIAL DIAGNOSIS", [ "Bronchogenic carcinoma (most likely — spiculated mass, heterogeneous enhancement, pleural + adrenal mets)", "Pleural mesothelioma (can cause pleural thickening, but primary lesion not pleural here)", "Pulmonary carcinoid (less likely — usually central, well-defined, no spiculation)", "Pulmonary metastasis from unknown primary (no known primary history — primary in lung favored)", ]) add_qa_section(doc, [ ("What are the CT features of malignancy in a lung mass?", "Spiculated or lobulated margins, size >3 cm, heterogeneous enhancement, pleural/chest wall invasion, mediastinal lymphadenopathy, satellite nodules, associated pleural effusion/thickening."), ("What is the significance of spiculated margins on CT?", "Spiculation indicates desmoplastic reaction from tumor infiltration into adjacent lung parenchyma — strongly associated with malignancy (PPV >90%). Also called 'corona radiata' sign."), ("What does the right adrenal enlargement with enhancement suggest?", "Adrenal metastasis — adrenals are a common site for lung cancer metastases (esp. adenocarcinoma). Enhancing, bulky adrenal on CT in context of lung mass is highly suspicious."), ("What is the significance of ICD tube position?", "ICD tip should ideally be at the apex for pneumothorax and base/dependent position for fluid. Here the tip is toward the diaphragmatic region — appropriate for draining pleural fluid/hemothorax."), ("What is the next step in management?", "PET-CT for staging + CT-guided biopsy (HPE) for tissue diagnosis and molecular profiling (EGFR, ALK, PD-L1)."), ]) add_key_teaching(doc, [ "Spiculated LUL mass = bronchogenic carcinoma until proven otherwise", "Pleural deposits in lung cancer indicate T4 disease (Stage IVA when ipsilateral, IVB with distant mets)", "Adrenal metastasis: 'bulky enhancing adrenal' on CECT — check bilaterally in all lung CA cases", "Corona radiata sign: spiculation from a pulmonary nodule — high specificity for malignancy", ]) add_divider(doc) doc.add_page_break() # ======================================================== # CASE 2: RAMANJANEYA — CECT ABDOMEN (Lung mass incidentally detected) # ======================================================== add_case_header(doc, "02", "Ramanjaneya", "68Y / M", "CECT ABDOMEN (+ Screening Thorax)", "06-Mar-2026") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "68-year-old male; CECT abdomen performed — lung mass detected on screening thorax", "Multiple systemic metastases on single scan", ]) add_section(doc, "KEY IMAGING FINDINGS — THORAX (Screening)", [ "Soft tissue mass (36 × 25 × 32 mm) in superior segment of left lower lobe with spiculations and lobulated margins", "Extension across the oblique fissure with cut-off of superior segment bronchi", "Mild heterogeneous enhancement", "Malignant-appearing mediastinal lymph nodes: aorto-pulmonary window (25×18 mm), pre-tracheal, pre-carinal, sub-carinal", ]) add_section(doc, "KEY IMAGING FINDINGS — ABDOMEN", [ "LIVER: Hypodense lesions (segments IV, VI, VIII) with mild peripheral arterial enhancement + relative hypodensity on venous phase — 'washout pattern' = hepatic metastases", "Left kidney: cortical cyst, mid-pole scarring, tiny calculus (2-3 mm)", "Right kidney: normal", "Prostate: enlarged (USG correlation needed)", "Bladder: circumferential wall thickening — chronic cystitis", "Aorta: moderate atherosclerotic changes", ]) add_section(doc, "KEY IMAGING FINDINGS — BONES", [ "Ill-defined lytic areas in D5, D7, D8, D9, D12 vertebrae, left iliac crest, left pelvic brim — metastatic deposits", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "PRIMARY: Lobulated left lung mass — likely primary bronchogenic carcinoma", "METASTASES: Mediastinal nodes + hepatic deposits + multifocal bony metastases", "Stage IV disease — PET-CT + HPE recommended", ]) add_section(doc, "DIFFERENTIAL DIAGNOSIS for HEPATIC LESIONS", [ "Metastatic deposits (most likely — multiple, peripheral rim enhancement, washout, in context of lung mass)", "Hepatocellular carcinoma (would expect cirrhotic liver, AFP elevation, arterial enhancement with washout from HCC nodules)", "Hemangiomas (peripheral nodular enhancement with progressive fill-in — not washout)", "Abscesses (rim-enhancing, fever, leukocytosis — less likely here)", ]) add_qa_section(doc, [ ("What is the 'washout pattern' in hepatic lesions on CECT?", "Peripheral arterial enhancement followed by relative hypodensity (washout) on portal/venous phase — seen in HCC and hypervascular metastases. Classic for hypervascular mets (renal cell, neuroendocrine, thyroid, breast)."), ("How do you differentiate hepatic metastases from hemangiomas on CT?", "Hemangiomas: peripheral nodular enhancement with progressive centripetal fill-in (becomes isodense to blood pool on delayed phase). Metastases: variable enhancement patterns, often peripheral rim, with washout; rarely fill in completely."), ("What mediastinal nodal stations are involved here?", "AP window (station 5), pre-tracheal (station 3), pre-carinal/subcarinal (station 7) — indicates N2 disease (ipsilateral mediastinal nodes)."), ("What is the significance of bronchial cut-off on CT?", "Bronchial cut-off indicates endobronchial or peribronchial tumor involvement with obstruction. Leads to post-obstructive atelectasis/pneumonia distal to the obstruction."), ]) add_key_teaching(doc, [ "Always view screening thorax images even when the primary study is abdomen — incidental lung masses are not uncommon", "Hepatic metastases: multiple, bilateral, peripheral rim enhancement — think lung, colon, breast, pancreas primaries", "Vertebral lytic mets from lung CA: commonly multifocal, ill-defined — differentiate from myeloma (punched-out), Paget's (expanded, sclerotic)", "AP window LN > 15 mm short axis = pathological", ]) add_divider(doc) doc.add_page_break() # ======================================================== # CASE 3: ANNAPOORNAMMA — CECT THORAX + ABDOMEN (Breast Ca follow-up) # ======================================================== add_case_header(doc, "03", "Annapoornamma", "58Y / F", "CECT THORAX + ABDOMEN", "12-May-2026") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "58-year-old female, known case of breast cancer, on chemotherapy", "Evaluation for suspected liver metastases", ]) add_section(doc, "KEY IMAGING FINDINGS", [ "BREAST: Multiple bilateral spiculated soft tissue lesions — largest left UOQ (29×19 mm), right UOQ (20×18 mm) — multifocal bilateral disease", "AXILLA: Multiple subcentimetric bilateral heterogeneously enhancing axillary lymph nodes", "LUNGS: Clear — no pulmonary metastatic nodules", "LIVER: Multiple hypodense lesions with peripheral rim enhancement throughout parenchyma, largest 22×20 mm (segment IVA) — hepatic metastases", "BONE: T3 vertebra — diffuse homogeneous sclerosis (IVORY VERTEBRA) — sclerotic metastasis", "L3 vertebra — anterior wedge compression (~25% height loss) — likely pathological/osteoporotic", "Gallbladder, spleen, pancreas, adrenals: unremarkable", "No ascites or intra-abdominal lymphadenopathy", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "Known multifocal bilateral breast carcinoma with hepatic metastases", "T3 ivory vertebra — sclerotic osseous metastasis", "L3 anterior wedge compression — pathological vs osteoporotic (clinical correlation needed)", "No pulmonary metastases detected", ]) add_section(doc, "DIFFERENTIAL FOR IVORY VERTEBRA", [ "Sclerotic metastasis — breast, prostate (most common causes)", "Lymphoma (Hodgkin's) — classic ivory vertebra", "Paget's disease — enlarged vertebra with cortical thickening, picture-frame appearance", "Myeloma (sclerotic variant — POEMS syndrome)", "Osteoblastic osteosarcoma (rare in vertebra)", ]) add_qa_section(doc, [ ("What is an 'ivory vertebra' and what are its causes?", "Ivory vertebra is uniformly increased density of a vertebral body on plain film/CT, with preserved size and shape. Causes (mnemonicHOLM): Hodgkin's lymphoma, Osteoblastic mets (breast/prostate), Lymphoma, Myeloma (sclerotic), + Paget's disease. In a female with breast cancer, sclerotic metastasis is #1 cause."), ("How does breast cancer typically metastasize to bone?", "Breast cancer produces both lytic and sclerotic (blastic) metastases. Sclerotic pattern is common after chemotherapy or with lobular subtype. Sites: vertebrae, ribs, pelvis, femur (axial > appendicular skeleton)."), ("What enhancement pattern do hepatic metastases from breast cancer show?", "Peripheral rim enhancement on arterial phase with central hypodensity (due to necrosis) — 'ring-enhancing' lesions. They remain hypodense relative to liver on portal phase."), ("What is the significance of 'no pulmonary metastases' in breast cancer?", "Pulmonary metastases indicate Stage IV disease (M1). Their absence is prognostically favorable. Breast cancer can metastasize to lung (nodules, lymphangitic carcinomatosis), liver, bone, and brain."), ("What is lymphangitic carcinomatosis and how does it appear on CT?", "Tumor spread via pulmonary lymphatics. CT: smooth or nodular thickening of bronchovascular bundles and interlobular septa, Kerley B lines, with preserved lung architecture — 'beaded septum sign'."), ]) add_key_teaching(doc, [ "Ivory vertebra in a female with breast cancer = sclerotic metastasis (T3 level here)", "Hepatic metastases: peripheral rim enhancement — distinguish from HCC (arterial blush with washout)", "No pulmonary mets does NOT mean clear — lymphangitic spread can be subtle; correlate clinically", "Bilateral breast lesions in known Ca: document size, segment, and compare with prior for treatment response", ]) add_divider(doc) doc.add_page_break() # ======================================================== # CASE 4: MAHALINGAPPA — CECT KUB (Genitourinary TB) # ======================================================== add_case_header(doc, "04", "Mahalingappa", "35Y / M", "CECT KUB", "11-May-2026") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "35-year-old male; abdominal pain x5 days", "Known case of CKD on hemodialysis", ]) add_section(doc, "KEY IMAGING FINDINGS", [ "LEFT KIDNEY: Small, contracted, cortical scarring, diffuse parenchymal thinning", "Asymmetric caliectatic changes with peripheral calyceal calcification", "Hyperdense non-enhancing contents (100-110 HU) in left upper/lower pole calyces, renal pelvis, and proximal ureter (~16-17 cm length) with amorphous calcific foci — NO post-contrast enhancement", "Circumferential mural thickening of left ureter (~5.2 mm)", "Left upper pole calyceal calculi: largest ~7.8 mm, attenuation ~600 HU", "Minimal left perinephric fat stranding", "Few subcentimetric left renal hilar and para-aortic lymph nodes", "RIGHT KIDNEY: Normal size, shape, attenuation; mild delayed excretion of contrast (secondary to CKD)", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "PRIMARY DIAGNOSIS: Genitourinary Tuberculosis (GUTB)", "Features: contracted kidney, calyceal calcification, hyperdense non-enhancing pelvicalyceal contents, ureteric wall thickening, parenchymal scarring", "DIFFERENTIAL: Urothelial carcinoma / TCC (less likely: no enhancement + younger age + CKD context)", "Recommend: Urine AFB/CBNAAT, urine culture", ]) add_section(doc, "DIFFERENTIAL DIAGNOSIS", [ "Genitourinary TB (MOST LIKELY): contracted kidney, calyceal calcification, non-enhancing contents, ureteric thickening, lower lobe/upper pole predilection", "Urothelial carcinoma / TCC: enhancing soft tissue mass filling collecting system — EXCLUDED by no enhancement", "Xanthogranulomatous pyelonephritis (XGP): enlarged kidney (not contracted), lipid-filled cavities (HU negative), staghorn calculus", "Pyonephrosis: dilated collecting system with debris, but typically no calcification pattern of TB", ]) add_qa_section(doc, [ ("What are the CT features of genitourinary tuberculosis (GUTB)?", "Renal: cortical scarring, parenchymal calcification ('putty kidney' = autonephrectomy), polar calcification, small contracted kidney, calyceal infundibular stenosis, moth-eaten calyces. Ureter: beaded/corkscrew ureter, wall thickening, strictures. Bladder: thickened wall, reduced capacity, calcification."), ("What is 'putty kidney' or autonephrectomy in TB?", "End-stage renal TB where the entire kidney becomes calcified and non-functioning — the kidney is replaced by caseous material that calcifies (dystrophic calcification). It appears as a densely calcified renal outline on plain X-ray/CT."), ("What is the significance of non-enhancing hyperdense contents in the collecting system?", "Hyperdense (100-110 HU) non-enhancing contents represent inspissated caseous material, pus, or calcified debris within the collecting system — classic for TB. Absence of enhancement excludes viable enhancing tumor (TCC)."), ("How does GUTB reach the kidney?", "Hematogenous spread from primary pulmonary TB → cortical microabscesses → papillary necrosis → cavitation → calyceal involvement → ureter → bladder. Always look for upper lobe pulmonary TB on the same scan."), ("What is ureteric involvement in TB?", "Circumferential wall thickening, strictures (often multiple, lower ureter > upper), 'beaded ureter', 'pipe-stem ureter' (rigid, thick-walled, non-dilated). Here: 5.2 mm wall thickening over 16-17 cm length."), ]) add_key_teaching(doc, [ "GUTB: contracted kidney + calyceal calcification + non-enhancing hyperdense contents + ureteral thickening = classic triad", "Key differentiator from TCC: NO post-contrast enhancement of the pelvicalyceal contents", "Always check for coexisting pulmonary TB — look at the lung bases on abdominal CT", "Urine AFB and CBNAAT (Xpert MTB/RIF): send EARLY MORNING urine x3 consecutive days for diagnosis", "Polar predilection: TB affects upper and lower poles of kidney first (superior blood supply = higher pO2 = mycobacterial tropism)", ]) add_divider(doc) doc.add_page_break() # ======================================================== # CASE 5: CHIKKAMMA — CECT THORAX + ABDOMEN (Right Breast IDC) # ======================================================== add_case_header(doc, "05", "Chikkamma", "45Y / F", "CECT THORAX + ABDOMEN", "13-May-2026") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "45-year-old female; biopsy-proven right breast invasive ductal carcinoma (IDC)", "Presenting with abdominal distension — staging CT", ]) add_section(doc, "KEY IMAGING FINDINGS", [ "RIGHT BREAST MASS: Heterogeneously enhancing lobulated lesion (3.0 × 6.4 × 4.2 cm) with internal necrotic areas; skin thickening (6 mm) — locally advanced", "Lesion abutting right pectoralis major — no definite infiltration", "AXILLA: Bilateral enlarged heterogeneously enhancing lymph nodes (right 20×16 mm; left 17×16 mm) — likely metastatic bilateral axillary nodes", "LUNGS: Bilateral apical pleural thickening with fibrotic changes; NO pulmonary nodules or metastases", "MEDIASTINUM: No mediastinal/hilar lymphadenopathy", "ABDOMEN: Liver, spleen, kidneys, adrenals — all normal; no hepatic metastases; no ascites", "UTERUS/OVARIES: Grossly normal; left ovary shows dominant follicle (23×20 mm) — physiological", "BONES: Grade I anterolisthesis L5 over S1 with bilateral L5 pars defects — spondylolysis; NO lytic/sclerotic mets", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "Right breast IDC — locally advanced with skin thickening; abutting pectoralis (no infiltration)", "Bilateral axillary lymphadenopathy — likely bilateral nodal metastases (N3c stage implication)", "NO visceral (lung/liver) or bone metastases", "Note: Abdominal distension not explained by CT findings — clinical correlation advised", ]) add_section(doc, "STAGING IMPLICATIONS", [ "Primary tumor: Large (T3 or T4b with skin thickening/involvement)", "Nodes: Bilateral axillary — N3c (contralateral axillary mets = M1 by AJCC 8th edition)", "Metastasis: M0 (no distant organ mets on this scan)", ]) add_qa_section(doc, [ ("What CT features suggest locally advanced breast cancer?", "Mass >5 cm (T3), chest wall invasion (pectoralis, ribs, intercostals — T4a), skin thickening/edema/satellite nodules (T4b), inflammatory changes (T4d). This case: 6.4 cm + skin thickening = at least T4b."), ("What is the significance of bilateral axillary lymphadenopathy in right breast cancer?", "Ipsilateral axillary nodes = N1-N3a depending on number/extent. Contralateral axillary nodes = M1 (distant metastasis) by AJCC 8th edition — changes management from curative to palliative intent."), ("What are CT criteria for pathological axillary lymph nodes?", "Short axis >10 mm, loss of fatty hilum, round shape (normal = oval), heterogeneous/rim enhancement, central necrosis. Here: largest 20×16 mm with heterogeneous enhancement."), ("What is the significance of a dominant follicle in the left ovary?", "A dominant follicle (18-25 mm) is a normal physiological finding in a premenopausal female at mid-cycle. It should NOT be mistaken for a cyst or mass. Follow-up USG if uncertain."), ("What is spondylolysis and how does it appear on CT?", "Stress fracture through the pars interarticularis of the vertebra (most common at L5). CT: oblique lucency/defect through pars interarticularis. Bilateral pars defects at L5 → spondylolisthesis (L5 slips forward over S1) — Grade I here = <25% slip."), ]) add_key_teaching(doc, [ "Breast Ca staging CT: systematically assess — breast mass size/depth, chest wall (T4a), skin (T4b), ipsi/contralateral axilla, internal mammary, mediastinal nodes, lungs, liver, bones, adrenals", "Skin thickening >2 mm in breast Ca = T4b (clinical T, but CT confirms extent)", "Dominant follicle: do NOT over-report as cystic lesion — mention 'physiological dominant follicle'", "Pars interarticularis defect: classic 'Scotty dog with collar' sign on oblique X-ray; lucency on CT", ]) add_divider(doc) doc.add_page_break() # ======================================================== # CASE 6: BASAVARAJU — HRCT THORAX (Hydropneumothorax) # ======================================================== add_case_header(doc, "06", "Basavaraju", "50Y / M", "HRCT THORAX", "10-Jul-2026") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "50-year-old male; cough, fever, breathlessness for 15 days", "Referred for HRCT thorax", ]) add_section(doc, "KEY IMAGING FINDINGS", [ "GROSS RIGHT HYDROPNEUMOTHORAX — tense and loculated", "Largest collection: ~21.0 × 9.5 × 14.0 cm (estimated volume ~1500 cc)", "Associated mild pleural thickening", "MASS EFFECT: Near-complete collapse of right lung (sparing right apex and anterior segments)", "Leftward tracheomediastinal shift — contralateral mediastinal displacement", "Flattening and inferior displacement of right hemidiaphragm with mild indentation over right hepatic lobe", "Small right paratracheal cyst (~12×10 mm)", "Few small pretracheal and right paratracheal lymph nodes — likely reactive", "LEFT LUNG: Clear — no consolidation, nodule, or mass", "No cavitary lesion in visualized aerated right lung", "No left pleural effusion or pneumothorax", "Cardia within normal limits", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "GROSS RIGHT HYDROPNEUMOTHORAX (~1500 cc) — tense/loculated; near-complete right lung collapse with leftward mediastinal shift", "Etiology: Cannot determine from CT alone (no cavitary lesion visible in aerated lung) — pleural fluid analysis needed", "DDx: Empyema with bronchopleural fistula, post-traumatic, malignant effusion with spontaneous pneumothorax, ruptured pulmonary abscess", ]) add_section(doc, "DIFFERENTIAL DIAGNOSIS", [ "Empyema with bronchopleural fistula (most common cause of hydropneumothorax in this age group — fever, cough)", "Spontaneous pneumothorax + pleural effusion (usually young males, tall, thin; simultaneous effusion suggests secondary cause)", "Post-traumatic hemopneumothorax (no history of trauma here)", "Malignant pleural disease with effusion + pneumothorax (less likely — no mass visible)", "Esophagopleural fistula (rare)", ]) add_qa_section(doc, [ ("What is hydropneumothorax and how is it diagnosed on CT?", "Hydropneumothorax = simultaneous presence of air and fluid in the pleural cavity. On CT: horizontal air-fluid level within the pleural space (best seen on erect or lateral decubitus); anterior air + posterior fluid layering. The fluid can be serous, bloody (hemopneumothorax), or purulent (pyopneumothorax)."), ("What is tracheomediastinal shift and when does it occur?", "Shift of trachea and mediastinum AWAY from the pathological side indicates mass effect (tension pneumothorax, large effusion, hydropneumothorax). Shift TOWARD the pathological side indicates volume loss (atelectasis, fibrosis)."), ("What are CT features that distinguish simple effusion from empyema?", "Empyema: lenticular shape, split pleura sign (thickened visceral + parietal pleura with enhancing layers), internal septations, loculation, increased attenuation (>20 HU). Simple effusion: crescentic shape, no pleural thickening, <10 HU."), ("What is the 'split pleura sign'?", "Thickening and enhancement of both visceral and parietal pleural layers separated by fluid — characteristic of empyema on CECT. Helps differentiate empyema from peripheral lung abscess (abscess: thick-walled, spherical, within lung parenchyma)."), ("What is a bronchopleural fistula (BPF)?", "Abnormal communication between bronchial tree and pleural space. Causes: post-pneumonectomy, necrotizing pneumonia, TB, lung abscess rupture. CT: air in pleural space after drainage, change in air-fluid level, direct fistulous tract (seen in 30-40% cases)."), ]) add_key_teaching(doc, [ "Hydropneumothorax = fluid + air in pleura; horizontal air-fluid level is pathognomonic", "Tracheomediastinal shift AWAY from lesion = mass effect (tension physiology) — emergency!", "~1500 cc volume + near-complete lung collapse = significant, likely requires urgent drainage", "Always look for underlying cause: cavitary lesion, mass, prior surgery, trauma history", "Loculated collections = empyema/clotted hemothorax — may need image-guided drain or surgical drainage", ]) add_divider(doc) doc.add_page_break() # ======================================================== # CASE 7: CHKKARNGAIAH — CECT NECK (Pyriform Fossa Mass) # ======================================================== add_case_header(doc, "07", "Chkkarngaiah", "88Y / M", "CECT NECK", "13-Mar-2026") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "88-year-old male; CECT neck for laryngopharyngeal mass evaluation", ]) add_section(doc, "KEY IMAGING FINDINGS", [ "Large heterogeneously enhancing lesion (2.4 × 4.8 × 5.2 cm) centered in LEFT PYRIFORM FOSSA — completely filling it", "MEDIAL EXTENSION: Left aryepiglottic fold, left lateral epiglottis, possible right aryepiglottic fold, right pyriform sinus effacement", "Left false vocal cord: bulky and devially medially", "Left paraglottic space: posterior aspect involved; fat stranding in remainder", "CARTILAGE INVASION: Left thyroid cartilage lamina (including superior/inferior cornua); close abutment of left cricoid and left arytenoid", "LATERAL: Involving left thyrohyoid membrane; abutting/displacing left SCM", "SUPERIOR: Tip of epiglottis involved; abutting inner cortex of left lateral hyoid bone (no definite cortical destruction)", "INFERIOR: Extends to post-cricoid region", "POSTERIOR: Abutting posterior pharyngeal wall", "Right laryngeal ventricle enlargement — likely left RLN palsy (vocal cord paralysis)", "Lymph nodes: subcentimetric level Ib and level II — no definite malignant features", "Lung apices: moderate emphysematous changes", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "PRIMARY DIAGNOSIS: Pyriform sinus carcinoma (hypopharyngeal carcinoma) — SCC most likely", "T4a disease: thyroid cartilage invasion", "N0 (by imaging — subcentimetric nodes without malignant features)", "Endoscopy + histopathological confirmation required", ]) add_section(doc, "DIFFERENTIAL DIAGNOSIS", [ "Pyriform sinus carcinoma / Hypopharyngeal SCC (most likely — 88% of hypopharyngeal cancers arise from pyriform sinus in males, strong tobacco association)", "Supraglottic laryngeal carcinoma with pyriform extension (primary in larynx vs hypopharynx)", "Thyroid carcinoma with laryngeal invasion (thyroid usually enlarged, different enhancement)", "Lymphoma (usually bilateral nodes, homogeneous, no cartilage destruction)", ]) add_qa_section(doc, [ ("What are the anatomical subsites of the hypopharynx?", "1) Pyriform sinuses (bilateral) — most common site of hypopharyngeal Ca (65-85%); 2) Posterior pharyngeal wall; 3) Post-cricoid region. The pyriform sinus is the recess between the thyroid cartilage and the aryepiglottic fold laterally and the larynx medially."), ("What is the T-staging of hypopharyngeal carcinoma?", "T1: Limited to one subsite, ≤2 cm. T2: >2 cm or more than one subsite or adjacent site, without fixation. T3: >4 cm or with fixation of hemilarynx or esophageal extension. T4a: thyroid/cricoid cartilage, hyoid, thyroid gland, esophagus, central compartment soft tissues. T4b: prevertebral fascia, carotid artery, mediastinal structures."), ("What are the CT features of cartilage invasion in head & neck cancer?", "Lytic destruction of cartilage cortex, sclerosis/reactive change in adjacent cartilage, soft tissue replacement of cartilage. Note: CT has ~74% sensitivity for thyroid cartilage invasion; MRI is superior for early invasion (T2 hyperintensity in cartilage marrow)."), ("What is the significance of an enlarged right laryngeal ventricle?", "Laryngeal ventricle enlargement suggests ipsilateral vocal cord paralysis (fixed or paralyzed cord in paramedian position). Here: likely left RLN palsy from tumor mass effect, causing compensatory right ventricle dilation — 'laryngeal ventricle sign'."), ("What nodal levels are important in hypopharyngeal carcinoma?", "Levels II, III, IV (deep cervical chain — highest risk). Level VI (paratracheal) for post-cricoid/posterior wall tumors. High rate of bilateral and retropharyngeal node involvement. Level Ib/II involvement here — common for pharyngeal primaries."), ]) add_key_teaching(doc, [ "Pyriform sinus Ca: fills the pyriform fossa, has strong tobacco/alcohol association — 88-year-old male is typical demographic", "Cartilage invasion = T4a — look for lytic destruction of thyroid cartilage (usually best on CT for cortical erosion)", "Paraglottic space involvement: loss of fat signal/density in paraglottic space = deep spread, affects operability", "Right laryngeal ventricle enlargement = left vocal cord palsy (ipsilateral) — document as 'likely left RLN involvement'", "Always check for synchronous esophageal/lung primary in hypopharyngeal Ca patients (field cancerization)", ]) add_divider(doc) doc.add_page_break() # ======================================================== # CASE 8: SUNANDAMMA — CT NECK (Parathyroid Adenoma + Brown Tumor) # ======================================================== add_case_header(doc, "08", "Sunandamma", "47Y / F", "CT NECK", "23-Apr-2025") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "47-year-old female; CT neck — likely evaluation of thyroid/parathyroid region", "Hypercalcemia / hyperparathyroidism suspected (given findings)", ]) add_section(doc, "KEY IMAGING FINDINGS", [ "Right thyroid lobe inferior aspect: hypodense lesion (18×12 mm) — LIKELY PARATHYROID ADENOMA", "Expansile lytic lesion with soft tissue content in: lamina, pedicle, and posterior aspect of T4 vertebra", "Lytic lesions in: right acromion process of scapula + lateral shaft of right clavicle", "Diffuse altered attenuation of all visualized bones", "Nasopharynx, oropharynx, hypopharynx: normal", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "PRIMARY DIAGNOSIS: Primary Hyperparathyroidism with Brown Tumors + Parathyroid Adenoma", "Parathyroid adenoma: inferior right lobe hypodense lesion (18×12 mm)", "Brown tumors: expansile lytic lesions at T4 vertebra, right acromion, right clavicle", "Diffuse altered bone attenuation: generalized osteitis fibrosa cystica (von Recklinghausen disease of bone)", ]) add_section(doc, "DIFFERENTIAL DIAGNOSIS for LYTIC BONE LESIONS", [ "Brown tumor of hyperparathyroidism (MOST LIKELY: multiple lytic lesions, expansile, soft tissue contents, parathyroid adenoma present, diffuse bone changes)", "Multiple myeloma (punched-out lytic lesions; Bence-Jones protein; no soft tissue expansion typically)", "Metastatic disease (irregular margins, often ill-defined; no associated parathyroid mass)", "Giant cell tumor (GCT) (usually epiphyseal in long bones, single lesion; not in vertebrae/clavicle/scapula)", "Aneurysmal bone cyst (ABC) (younger patients; expansile with fluid-fluid levels on MRI)", ]) add_qa_section(doc, [ ("What are Brown tumors and why do they occur?", "Brown tumors are non-neoplastic expansile lesions occurring in hyperparathyroidism (primary > secondary). Excess PTH causes osteoclast activation → fibrous replacement of bone with hemorrhage and hemosiderin deposition (brown color). On CT: expansile lytic lesion with soft tissue contents, no matrix. On MRI: heterogeneous T1/T2 due to blood products. They regress after parathyroidectomy."), ("What is the CT appearance of a parathyroid adenoma?", "Hypodense oval lesion posterior to or inferior to thyroid lobe, typically <3 cm, smooth margins, mild homogeneous enhancement. Location: most common at inferior poles of thyroid (80%); 10-15% ectopic (mediastinum, intrathyroidal). Gold standard localization: Sestamibi scan (Tc-99m) + 4D-CT/ultrasound."), ("What is the radiological triad of primary hyperparathyroidism?", "1) Subperiosteal bone resorption (radial aspect of middle phalanges — pathognomonic on X-ray); 2) Brown tumors (expansile lytic lesions); 3) Nephrocalcinosis/nephrolithiasis. Advanced: 'salt and pepper skull', rugger jersey spine, generalized osteoporosis."), ("What is 'osteitis fibrosa cystica' (von Recklinghausen disease of bone)?", "Advanced skeletal manifestation of primary hyperparathyroidism. Widespread bone resorption replaced by fibrous tissue with multiple brown tumors — now rare due to early biochemical detection of hypercalcemia."), ("How do you differentiate parathyroid adenoma from a thyroid nodule on CT?", "Parathyroid adenoma: posterior to thyroid, separate from thyroid, hypodense (lower attenuation than thyroid), often at inferior pole, enhances less than thyroid. Thyroid nodule: within thyroid parenchyma. USG: parathyroid adenoma is hypoechoic, posterior to thyroid, moves with thyroid on swallowing."), ]) add_key_teaching(doc, [ "Brown tumor + parathyroid adenoma on same scan = primary hyperparathyroidism diagnosis", "Subperiosteal resorption of radial aspect of middle phalanges on hand X-ray = PATHOGNOMONIC for hyperparathyroidism", "Brown tumors MIMIC malignant lesions (expansile lytic) — look for parathyroid adenoma and check serum Ca/PTH", "Parathyroid adenoma localization: 4D-CT (arterial phase enhancement + venous phase washout) is increasingly used pre-op", "Rugger jersey spine: alternating sclerotic/lucent bands in vertebrae (H-P'thyroidism, renal osteodystrophy)", ]) add_divider(doc) doc.add_page_break() # ======================================================== # CASE 9: NARASIMHAMURTHY — MRI LEFT KNEE (Bone Tumor) # ======================================================== add_case_header(doc, "09", "Narasimhamurthy", "35Y / M", "MRI LEFT KNEE", "11-May-2026") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "35-year-old male; swelling of left knee for 6 months", "Multiplanar multisequence MRI of left knee performed", ]) add_section(doc, "KEY IMAGING FINDINGS", [ "LESION: Expansile, mildly lobulated metaepiphyseal lesion at lateral aspect of distal femur (6.1 × 4.8 × 7.6 cm)", "T1: Predominantly intermediate signal with subtle T1 hyperintense areas (cystic/hemorrhagic components)", "T2/STIR: Heterogeneous hyperintensity", "DWI: Few internal areas of diffusion restriction", "Adjacent soft tissue extension (mild)", "Adjacent muscular edema (STIR hyperintensity)", "Multiple surrounding T2 hypointense flow voids — increased perilesional vascularity", "NO articular surface/joint extension", "MENISCI: Grade I degeneration of lateral meniscus body and posterior horn (no tear)", "Ligaments (ACL, PCL, MCL, LCL): intact", "No joint effusion", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "PRIMARY DIFFERENTIAL: Giant Cell Tumor (GCT) with secondary Aneurysmal Bone Cyst (ABC) changes — most likely", "DDx: Chondromyxoid fibroma (less likely), Telangiectatic osteosarcoma (less likely)", "Features favoring GCT-ABC: metaepiphyseal location, distal femur, age 35M, expansile with fluid-fluid levels/hemorrhagic areas", "Features favoring telangiectatic OSA: aggressive features (soft tissue extension, muscular edema, vascularity, diffusion restriction)", "HPE correlation recommended", ]) add_section(doc, "DIFFERENTIAL DIAGNOSIS — EPIPHYSEAL/METAEPIPHYSEAL BONE LESIONS", [ "Giant Cell Tumor (GCT): Epiphyseal, skeletally mature (20-40y), distal femur/proximal tibia/distal radius, extends to subchondral bone, T2 intermediate (hemosiderin), no internal matrix", "Aneurysmal Bone Cyst (ABC): Expansile, fluid-fluid levels on MRI (T2 hyper/hypo), younger age; secondary ABC complicates GCT (→ GCT-ABC)", "Telangiectatic Osteosarcoma: Appears like ABC but aggressive periosteal reaction (Codman's triangle, sunburst), soft tissue mass, rapid growth; DWI restriction common", "Chondromyxoid Fibroma (CMF): Metaphyseal (not epiphyseal), eccentric, lobulated, geographic pattern; rare", "Clear Cell Chondrosarcoma: Epiphyseal, similar to GCT but older age, matrix calcification possible", ]) add_qa_section(doc, [ ("What are the classic MRI features of Giant Cell Tumor (GCT)?", "Epiphyseal/metaepiphyseal location, distal femur > proximal tibia > distal radius. T1: intermediate/low signal. T2: heterogeneous — areas of low signal (hemosiderin from repeated hemorrhage). STIR: heterogeneous hyperintensity. Enhancement: heterogeneous. Fluid-fluid levels if secondary ABC. Rarely restricted on DWI."), ("How do you differentiate GCT from Telangiectatic Osteosarcoma (TOS) on MRI?", "Both are expansile, hemorrhagic, with fluid-fluid levels. TOS: Aggressive features — periosteal reaction (Codman's triangle, sunburst), soft tissue mass, cortical breakthrough, matrix (no chondroid), older periosteal reaction, DWI restriction, rapid growth. GCT: More geographic, butt up against subchondral bone, no periosteal reaction (or thin shell), occurs in mature skeleton."), ("What is a fluid-fluid level on MRI and what does it signify?", "Horizontal layering of two fluid components of different signal intensities within a lesion (upper = serum T2 bright; lower = blood products T1 bright/T2 variable). Seen in: ABC, GCT-ABC, TOS, simple bone cyst with fracture. NOT specific — but strongly suggests hemorrhagic/cystic component."), ("What are MRI grading criteria for meniscal tears?", "Grade 0: Normal (no signal change). Grade 1: Globular intrameniscal signal not reaching articular surface. Grade 2: Linear intrasubstance signal not reaching articular surface (myxoid degeneration — not a tear). Grade 3: Signal extending to articular surface = TRUE TEAR. This case: Grade I lateral meniscus (degeneration, not tear)."), ("What is the significance of flow voids on MRI?", "Flow voids appear as T2 hypointense tubular structures representing fast-flowing blood in vessels — indicates increased perilesional vascularity (neovascularity/hyperemia). Seen in hypervascular tumors (osteosarcoma, GCT, hemangioma, AVM). Multiple flow voids around a bone lesion suggest aggressive or vascular pathology."), ]) add_key_teaching(doc, [ "GCT: Epiphyseal, distal femur, 20-40 years, extends to subchondral bone — 'butt up against articular surface'", "Rule of thumb: GCT must abut the articular surface — if it doesn't, reconsider diagnosis", "Fluid-fluid levels in bone lesions: ABC (primary or secondary) — also seen in TOS (cannot distinguish on MRI alone)", "Grade II meniscal signal = degeneration (NOT a tear) — do NOT misreport as tear; only Grade III = tear", "DWI restriction in bone tumor = higher cellularity → favors malignancy (e.g., Ewing's, osteosarcoma vs benign ABC)", ]) add_divider(doc) doc.add_page_break() # ======================================================== # CASE 10: PUTTARAJU — CECT THORAX (Lung Ca with Metastases) # ======================================================== add_case_header(doc, "10", "Puttaraju", "74Y / M", "CECT THORAX", "13-Mar-2026") doc.add_paragraph() add_section(doc, "CLINICAL CONTEXT", [ "74-year-old male; CECT thorax — peripheral right lower lobe mass with systemic metastases", ]) add_section(doc, "KEY IMAGING FINDINGS", [ "PRIMARY LESION: Well-defined peripheral juxta-pleural soft tissue density mass (6.5 × 5.5 cm) in superior segment of right lower lobe — heterogeneous enhancement, no internal calcification", "LUNGS: Ground-glass opacities with few nodules in right lung (multiple lobes); bilateral upper lobe centrilobular emphysema; right upper lobe paraseptal emphysema; few right upper lobe calcified granulomas + fibrotic bands (old TB?)", "PLEURA: Mild right apical pleural thickening; mild right pleural effusion with interlobar/fissural extension", "MEDIASTINAL NODES: Enlarged heterogeneously enhancing nodes in pre-paratracheal, prevascular, AP window, subcarinal (largest 28×19 mm subcarinal) — nodal metastases", "HEPATIC METASTASES: Multiple well-defined heterogeneously enhancing hypodense lesions in both liver lobes; largest 19×19 mm (segment VII)", "ADRENAL METASTASES: Bilateral bulky adrenal glands with heterogeneous enhancement", "BONE METASTASES: Ill-defined osteolytic lesions in D9, D11, D12 vertebrae; undisplaced right 10th rib posterior fracture", "THYROID: Few relatively defined hypodense lesions — USG neck correlation needed", ]) add_section(doc, "IMPRESSION / DIAGNOSIS", [ "PRIMARY: Right lower lobe peripheral lung carcinoma (juxta-pleural) — Stage IV (systemic metastases)", "METASTASES: Mediastinal nodes + hepatic (bilateral lobes) + bilateral adrenal + vertebral (D9, D11, D12) + possible rib fracture from met", "BACKGROUND: Emphysema (bilateral upper lobes) + old granulomatous disease", "Thyroid incidentaloma: USG neck recommended", "Management: HPE + PETCT for complete staging and molecular profiling", ]) add_section(doc, "DIFFERENTIAL DIAGNOSIS — JUXTA-PLEURAL MASS", [ "Bronchogenic carcinoma (most likely — 74y male, smoker background given emphysema, peripheral mass, systemic mets)", "Pleural-based mesothelioma (diffuse pleural thickening, history of asbestos; mass here is parenchymal with pleural abutting)", "Pulmonary carcinoid (well-defined, usually central, rarely juxta-pleural; less at age 74)", "Large solitary metastasis from unknown primary (possible — but overall picture with lung as likely primary)", ]) add_qa_section(doc, [ ("What are the typical locations of bronchogenic carcinoma subtypes?", "Central (perihilar): Squamous cell carcinoma, Small cell carcinoma. Peripheral: Adenocarcinoma (most common overall, juxta-pleural/subpleural), Large cell carcinoma. Bronchioloalveolar (AIS/MIA): Ground-glass or lepidic pattern. This juxta-pleural mass: likely adenocarcinoma."), ("What is the clinical significance of bilateral adrenal metastases?", "Adrenals are 4th most common site of metastasis (lung, breast, colon). Bilateral adrenal metastases can cause adrenal insufficiency (Addison's disease) if >90% of adrenal tissue is destroyed. Always check for symptoms (fatigue, hypotension, hyponatremia, hyperkalemia)."), ("What are calcified granulomas and what do they represent?", "Old healed granulomatous infection — most commonly TB (in India) or histoplasmosis. CT: dense calcified nodules (>200 HU), often with 'target', 'popcorn', or solid calcification. They do NOT enhance. Important to distinguish from current active disease or new metastatic nodules."), ("How do you differentiate a lung primary from a solitary pulmonary metastasis?", "Primary: Spiculation, pleural tags, air bronchograms, associated ipsilateral nodes, smoking history, no known primary elsewhere. Metastasis: Smooth margins, lower lobe predilection (haematogenous), multiple lesions, known primary, 'cannonball' appearance if large."), ("What is the significance of a right 10th rib undisplaced fracture with D9-D12 lytic vertebral lesions?", "In the context of multifocal lytic vertebral lesions in a lung cancer patient, a rib fracture likely represents a pathological fracture through a bony metastasis rather than traumatic. D9-D12 lytic lesions + rib fracture = widespread bony metastases (M1b), Stage IVB disease."), ]) add_key_teaching(doc, [ "Juxta-pleural peripheral mass in an elderly male = adenocarcinoma until proven otherwise (most common subtype overall)", "Bilateral adrenal involvement in lung Ca: ~5-10% of cases; always report and flag for endocrine assessment", "GGOs + lung nodules in the setting of a dominant mass: may represent aerogenous spread (adenocarcinoma) or background emphysema-related changes", "Rib fracture adjacent to lytic met = pathological fracture — do NOT under-report as 'incidental fracture'", "Thyroid incidentalomas on CT: follow current ACR guidance — report and recommend USG if >1 cm", ]) add_divider(doc) doc.add_page_break() # ======================================================== # SUMMARY TABLE # ======================================================== p = doc.add_paragraph() run = p.add_run("CASE SUMMARY TABLE") run.bold = True run.font.size = Pt(14) run.font.color.rgb = RGBColor(0x1F, 0x35, 0x64) p.alignment = WD_ALIGN_PARAGRAPH.CENTER doc.add_paragraph() table = doc.add_table(rows=11, cols=6) table.style = 'Table Grid' headers = ["#", "Patient", "Age/Sex", "Modality", "Key Diagnosis", "Important Teaching"] for i, h in enumerate(headers): cell = table.rows[0].cells[i] cell.text = h for para in cell.paragraphs: for run in para.runs: run.bold = True run.font.size = Pt(9) run.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF) from docx.oxml.ns import qn as _qn from docx.oxml import OxmlElement as _OE tc = cell._tc tcPr = tc.get_or_add_tcPr() shd = _OE('w:shd') shd.set(_qn('w:val'), 'clear') shd.set(_qn('w:color'), 'auto') shd.set(_qn('w:fill'), '1F3564') tcPr.append(shd) rows_data = [ ("01", "Mujeeb Khan", "66Y/M", "CECT Thorax", "Bronchogenic Ca LUL + Pleural/Adrenal Mets", "Corona radiata sign; adrenal met"), ("02", "Ramanjaneya", "68Y/M", "CECT Abd+Thorax", "Lung Ca LLL + Hepatic/Bone/Nodal Mets", "Washout pattern liver mets; lytic vertebrae"), ("03", "Annapoornamma", "58Y/F", "CECT Thorax+Abd", "Breast Ca + Hepatic Mets + Ivory Vertebra T3", "Ivory vertebra; rim-enhancing liver mets"), ("04", "Mahalingappa", "35Y/M", "CECT KUB", "Genitourinary Tuberculosis (GUTB)", "Non-enhancing hyperdense PCS; putty kidney"), ("05", "Chikkamma", "45Y/F", "CECT Thorax+Abd", "Right Breast IDC + Bilateral Axillary Nodes", "T4b staging; spondylolysis L5"), ("06", "Basavaraju", "50Y/M", "HRCT Thorax", "Gross Right Hydropneumothorax (~1500 cc)", "Split pleura sign; mediastinal shift"), ("07", "Chkkarngaiah", "88Y/M", "CECT Neck", "Left Pyriform Sinus Carcinoma (T4a)", "Cartilage invasion; RLN palsy sign"), ("08", "Sunandamma", "47Y/F", "CT Neck", "Parathyroid Adenoma + Brown Tumors (1°HPT)", "Brown tumor vs mets; subperiosteal resorption"), ("09", "Narasimhamurthy", "35Y/M", "MRI Left Knee", "GCT with ABC changes vs Telangiectatic OSA", "Fluid-fluid levels; GCT epiphyseal rule"), ("10", "Puttaraju", "74Y/M", "CECT Thorax", "Lung Ca RLL (Peripheral) + Multi-organ Mets", "Bilateral adrenal mets; pathological rib #"), ] for r_idx, row_data in enumerate(rows_data): row = table.rows[r_idx + 1] for c_idx, val in enumerate(row_data): row.cells[c_idx].text = val for para in row.cells[c_idx].paragraphs: for run in para.runs: run.font.size = Pt(8) doc.add_paragraph() p = doc.add_paragraph() p.add_run("Document prepared for Radiology Practical Exam preparation — R3 Resident, Sri Siddhartha Medical College Hospital | July 2026").italic = True p.alignment = WD_ALIGN_PARAGRAPH.CENTER # Save output = "/tmp/workspace/radiology-exam-cases/Radiology_Practical_Exam_Cases.docx" doc.save(output) print(f"Saved: {output}") PYEOF python3 /tmp/workspace/radiology-exam-cases/generate_cases.py