{"id":12248,"date":"2019-04-03T12:27:08","date_gmt":"2019-04-03T12:27:08","guid":{"rendered":"https:\/\/sbpt.org.br\/portal\/?p=12248"},"modified":"2019-04-03T12:27:08","modified_gmt":"2019-04-03T12:27:08","slug":"caso-clinico-fevereiro-2019","status":"publish","type":"post","link":"https:\/\/sbpt.org.br\/portal\/caso-clinico-fevereiro-2019\/","title":{"rendered":"Caso cl\u00ednico \u2013 Fevereiro 2019"},"content":{"rendered":"

T\u00edtulo<\/strong><\/p>\n

Fibrose pulmonar intersticial numa mulher de 57 anos.<\/p>\n

Autor<\/strong><\/p>\n

Dr. Eduardo Algranti
\nPneumologista, Chefe do Servi\u00e7o de Medicina da FUNDACENTRO, S\u00e3o Paulo<\/p>\n

Identifica\u00e7\u00e3o do caso<\/strong><\/p>\n

Paciente feminina, 57 anos, vi\u00fava, procedente de S\u00e3o Paulo, SP.<\/p>\n

Hist\u00f3ria Cl\u00ednica<\/strong><\/p>\n

Em 1995 iniciou quadro de dispneia aos esfor\u00e7os, de car\u00e1ter progressivo. Posteriormente, passou a apresentar espirros, obstru\u00e7\u00e3o nasal e piora da dispn\u00e9ia quando exposta a produtos qu\u00edmicos dom\u00e9sticos. N\u00e3o Fumante. Relata quadro de pneumonia em 1992.<\/p>\n

Encaminhada para avalia\u00e7\u00e3o pneumol\u00f3gica em outubro de 1998 por apresentar como queixa principal dispneia progressiva, altera\u00e7\u00f5es na radiografia de t\u00f3rax e antecedentes de trabalho em ind\u00fastria de artefatos de cer\u00e2mica<\/p>\n

Hist\u00f3ria Ocupacional<\/strong><\/p>\n

Iniciou atividades externas aos 18 anos. De 10\/1959 a 09\/1965 trabalhou como prensista de azulejos na Cer\u00e2mica A. De 01\/1966 a 05\/1968, trabalhou na mesma fun\u00e7\u00e3o na Cer\u00e2mica B. Posteriormente, trabalhou como passadeira por 30 anos.<\/p>\n

 <\/p>\n

\"\"<\/a>
Prensa de azulejos<\/figcaption><\/figure>\n

 <\/p>\n

\"\"<\/a>
Passando roupas<\/figcaption><\/figure>\n

 <\/p>\n

Exames iniciais<\/strong><\/p>\n

1. Radiografia de t\u00f3rax: presen\u00e7a de opacidades nodulares difusas de baixa densidade, interpretadas como grau de profus\u00e3o 3\/2, tamanho nodular p\/q e s\u00edmbolo ax.
\n2. Espirometria: CVF=1,85 (75%), VEF1=1,66 (91%), VEF1\/CVF=0,89<\/p>\n

 <\/p>\n

\"\"<\/a><\/p>\n

 <\/p>\n

Quest\u00e3o 1: Com os dados de hist\u00f3ria e exames complementares apresentados \u00e9 poss\u00edvel inferir que:<\/strong><\/p>\n

a) A hip\u00f3tese de silicose \u00e9 prov\u00e1vel
\nb) As queixas de espirros, obstru\u00e7\u00e3o nasal e dispn\u00e9ia associadas \u00e0 exposi\u00e7\u00e3o a produtos qu\u00edmicos sugerem sintomas compat\u00edveis com asma
\nc) A conflu\u00eancia de pequenas opacidades na radiografia \u00e9 sinal indicativo de doen\u00e7a evolutiva
\nd) Todas as alternativas acima est\u00e3o corretas.<\/p>\n

 <\/p>\n

Exames solicitados a posteriori<\/strong><\/p>\n

1. Tomografia computadorizada de t\u00f3rax<\/strong><\/p>\n

Infiltrado nodular de baixa densidade, com aspecto em vidro fosco centrolobular. N\u00f3dulos ao longo da cisura e n\u00f3dulos subpleurais. \u00c1reas de al\u00e7aponamento a\u00e9reo, septos espessados. G\u00e2nglios calcificados em proje\u00e7\u00e3o hilar e na janela aorto-pulmonar.<\/p>\n

 <\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

 <\/p>\n

2. Anatomopatol\u00f3gico de material de bi\u00f3psia pulmonar a c\u00e9u aberto<\/strong><\/p>\n

Fibrose intersticial predominantemente peribr\u00f4nquica e perivascular. Presen\u00e7a de infiltrado linfocit\u00e1rio intenso, com deposi\u00e7\u00e3o de material particulado fino, birrefringente \u00e0 luz polarizada, com raras c\u00e9lulas gigantes.<\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

 <\/p>\n

Quest\u00e3o 2 – Com rela\u00e7\u00e3o \u00e0 bi\u00f3psia pulmonar no diagn\u00f3stico de pneumoconioses:<\/strong><\/p>\n

a) Por serem doen\u00e7as difusas, o m\u00e9todo de bi\u00f3psia transbr\u00f4nquica \u00e9 o de elei\u00e7\u00e3o
\nb) \u00c9 indicada em casos em que os achados de imagem n\u00e3o correspondem \u00e0s hist\u00f3ria ocupacional e cl\u00ednica
\nc) \u00c9 indicada para fins de comprova\u00e7\u00e3o objetiva em pleitos previdenci\u00e1rios e\/ou legais
\nd) Os achados histol\u00f3gicos s\u00e3o homog\u00eaneos em qualquer segmento pulmonar amostrado<\/p>\n

Quest\u00e3o 3 – Com as informa\u00e7\u00f5es de hist\u00f3ria, exames de imagem e bi\u00f3psia, \u00e9 poss\u00edvel concluir que:<\/strong><\/p>\n

a) Os achados s\u00e3o compat\u00edveis com silicose cl\u00e1ssica
\nb) A etiologia do processo pode ser tanto ocupacional como n\u00e3o ocupacional
\nc) Os achados sugerem pneumoconiose por poeira mista
\nd) O quadro \u00e9 revers\u00edvel com tratamento apropriado<\/p>\n

 <\/p>\n

 <\/p>\n

Bibliografia<\/strong><\/p>\n

    \n
  1. Honma K, Abraham JL, Chiyotani K, De Vuyst P, Dumortier P, Gibbs AR, Green FH, Hosoda Y, Iwai K, Williams WJ, Kohyama N, Ostiguy G, Roggli VL, Shida H, Taguchi O, Vallyathan V
    \nProposed criteria for mixed-dust pneumoconiosis: definition, descriptions, and guidelines for pathologic diagnosis and clinical correlation Hum Pathol. 2004 Dec;35(12):1515-23.<\/li>\n
  2. Baur X, Sanyal S, Abraham JL Mixed-dust pneumoconiosis: Review of diagnostic and classification problems with presentation of a work-related case, Sci Total Environ. 2019 Feb 20;652:413-421. doi: 10.1016\/j.scitotenv.2018.10.083. Epub 2018 Oct 12.<\/li>\n<\/ol>\n

     <\/p>\n

    Diagn\u00f3stico final<\/strong><\/p>\n

    pneumoconiose por poeiras mistas<\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n

    Respostas<\/strong><\/p>\n

    Quest\u00e3o 01: D
    \nQuest\u00e3o 02: C
    \nQuest\u00e3o 03: C<\/p>\n","protected":false},"excerpt":{"rendered":"

    T\u00edtulo Fibrose pulmonar intersticial numa mulher de 57 anos. Autor Dr. Eduardo Algranti Pneumologista, Chefe do Servi\u00e7o de Medicina da FUNDACENTRO, S\u00e3o Paulo Identifica\u00e7\u00e3o do caso Paciente feminina, 57 anos, vi\u00fava, procedente de S\u00e3o Paulo, SP. Hist\u00f3ria Cl\u00ednica Em 1995 iniciou quadro de dispneia aos esfor\u00e7os, de car\u00e1ter progressivo. Posteriormente, passou a apresentar espirros, obstru\u00e7\u00e3o […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"ngg_post_thumbnail":0,"footnotes":""},"categories":[15,478],"tags":[],"class_list":["post-12248","post","type-post","status-publish","format-standard","hentry","category-acesso-restrito","category-casos-clinicos-2019"],"acf":[],"yoast_head":"\nCaso cl\u00ednico \u2013 Fevereiro 2019 - sbpt.org.br<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sbpt.org.br\/portal\/caso-clinico-fevereiro-2019\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Caso cl\u00ednico \u2013 Fevereiro 2019 - sbpt.org.br\" \/>\n<meta property=\"og:description\" content=\"T\u00edtulo Fibrose pulmonar intersticial numa mulher de 57 anos. Autor Dr. Eduardo Algranti Pneumologista, Chefe do Servi\u00e7o de Medicina da FUNDACENTRO, S\u00e3o Paulo Identifica\u00e7\u00e3o do caso Paciente feminina, 57 anos, vi\u00fava, procedente de S\u00e3o Paulo, SP. Hist\u00f3ria Cl\u00ednica Em 1995 iniciou quadro de dispneia aos esfor\u00e7os, de car\u00e1ter progressivo. 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