{"id":9083,"date":"2018-02-02T15:29:04","date_gmt":"2018-02-02T15:29:04","guid":{"rendered":"https:\/\/sbpt.org.br\/portal\/?p=9083"},"modified":"2026-03-05T15:27:35","modified_gmt":"2026-03-05T18:27:35","slug":"caso-clinico-janeiro-2018","status":"publish","type":"post","link":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/","title":{"rendered":"Caso cl\u00ednico &#8211; Janeiro 2018"},"content":{"rendered":"<p><strong>Autores<\/strong><\/p>\n<p>Lilian s Ballini Caetano<br \/>\nM\u00e9dica Assistente da Disciplina de Pneumologia da EPM\/Unifesp<\/p>\n<p>Samir Drackoulakis<br \/>\nDoutor em Medicina pela Disciplina de Pneumologia da EPM\/Unifesp<\/p>\n<p>Ana Carolina Terra Cruz<br \/>\nResidente de Pneumologia da Disciplina de Pneumologia da EPM\/Unifesp<\/p>\n<p><strong>Relato do caso <\/strong><\/p>\n<p>SCM, feminina, 39 anos, branca, natural e procedente de S\u00e3o Paulo.<\/p>\n<p>Chiado no peito h\u00e1 15 anos, de dif\u00edcil controle, sendo encaminhada ao Ambulat\u00f3rio de asma grave.<\/p>\n<p>Paciente previamente h\u00edgida relata que h\u00e1 \u00b1 20 anos, ap\u00f3s acidente durante o trabalho, inalou grande quantidade de um g\u00e1s, sendo internada com quadro de dispn\u00e9ia intensa e irrita\u00e7\u00e3o nos olhos, sendo ent\u00e3o hospitalizada por 6 meses (20 dias em UTI, sem necessidade de IOT).<\/p>\n<p>Ap\u00f3s a alta evoluiu com pneumonias de repeti\u00e7\u00e3o (\u00b1 6 por ano), aumento da expectora\u00e7\u00e3o pulmonar e alguns epis\u00f3dios de escarros com sangue, tendo procurado PS v\u00e1rias vezes com queixa de tosse produtiva e chiado, sendo medicada com inala\u00e7\u00e3o e antibi\u00f3tico.<\/p>\n<p>H\u00e1 15 anos vem apresentando chiado no peito, principalmente \u00e0 noite, associado a epis\u00f3dios de dor tor\u00e1cica.<\/p>\n<p>Negava sintomas sugestivos de rinosinusopatia; Relatava sintomas de azia e eructa\u00e7\u00e3o que melhoravam ap\u00f3s uso de omeprazol; AP: sem antecedentes de tabagismo, sarampo ou coqueluche.<\/p>\n<p>Negava antecedentes de tuberculose pulmonar ou contato pr\u00e9vio com pacientes portadores de tuberculose.<\/p>\n<p>Antecedentes ocupacionais: 20 \u2013 21 anos (3 meses): trabalhou como servente exposta a produtos de limpeza 21 \u2013 21 anos (3 meses): trabalhou (3meses) como embaladeira em uma f\u00e1brica de sorvetes. Sem antecedentes familiares relevantes.<\/p>\n<p>Medica\u00e7\u00e3o em uso na \u00e9poca: Budesonida 800 mcg\u2019\/dia + Formoterol 24 mcg\/dia sem controle dos sintomas.<\/p>\n<p>Ao exame f\u00edsico: BEG, eupn\u00e9ica em AA com SpO2: 95% , IMC: 37,8Kg\/m2. PA: 135 x 70 mmHg FC : 82bpm FR: 15 ipm<\/p>\n<p>Aparelho respirat\u00f3rio com alguns roncos esparsos. CV: RCR em 2t sem sopros.Demais: ndn<\/p>\n<p style=\"text-align: center\"><strong>RX de t\u00f3rax atual (figura 1 e 2):<\/strong><\/p>\n<p style=\"text-align: center\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-9084\" src=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_01.jpg\" alt=\"\" width=\"400\" height=\"256\" srcset=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_01.jpg 400w, https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_01-300x192.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/p>\n<p style=\"text-align: center\">PA (figura 01)<\/p>\n<p style=\"text-align: center\">\n<p style=\"text-align: center\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-9085\" src=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_02.jpg\" alt=\"\" width=\"400\" height=\"279\" srcset=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_02.jpg 400w, https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_02-300x209.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/p>\n<p style=\"text-align: center\">Perfil (figura 02)<\/p>\n<p style=\"text-align: left\">\n<p style=\"text-align: center\"><strong>CT t\u00f3rax atual (figuras 3 e 4)<\/strong><\/p>\n<p style=\"text-align: center\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-9086\" src=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_03.jpg\" alt=\"\" width=\"400\" height=\"280\" srcset=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_03.jpg 400w, https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_03-300x210.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/p>\n<p style=\"text-align: center\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-9087\" src=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_04.jpg\" alt=\"\" width=\"400\" height=\"225\" srcset=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_04.jpg 400w, https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_04-300x169.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/p>\n<p style=\"text-align: left\">\n<p><strong>Laudo: Bronquiectasias difusas bilaterais<\/strong><\/p>\n<p><strong>Espirometria atual:<\/strong><\/p>\n<p>CVF pr\u00e9 BD: 1,84 L (56%); p\u00f3s BD: 1,83L (55%)<br \/>\nVEF1 pr\u00e9 BD: 1,53l (55%); p\u00f3s BD (1,56 L (56%)<br \/>\nVEF1\/CVF pr\u00e9 BD: 84%; p\u00f3s BD: 82%<\/p>\n<p><strong>Demais exames:<\/strong><\/p>\n<p>Hemograma: normal sem eosinofilia (3%); IgE: 58,3;FAN: 1\/160 pontilhado fino (demais exames reumatol\u00f3gicos sem altera\u00e7\u00f5es)<br \/>\nEscarro: Pesquisa direta para BAAR e cultura para micobacterias e fungos:negativa<br \/>\nSorologia para Aspergillus: negativa<\/p>\n<hr \/>\n<p><strong>Quest\u00e3o 01: Quanto ao diagnostico diferencial de asma grave, considerando a hist\u00f3ria clinica e os achados de bronquiectasias difusas \u00e0 CT t\u00f3rax, qual hip\u00f3tese mais prov\u00e1vel a considerar?<\/strong><\/p>\n<p>(a) \u2013 Aspergilose broncopulmonar al\u00e9rgica<br \/>\n(b) \u2013 Bronquiectasias secund\u00e1rias a inala\u00e7\u00e3o de g\u00e1s am\u00f4nia<br \/>\n(c) \u2013 Bronquiectasias por aspira\u00e7\u00e3o cr\u00f4nica<br \/>\n(d) \u2013 Colagenoses<br \/>\n(e) \u2013 Fibrose c\u00edstica<\/p>\n<p>As bronquiectasias difusas podem estar presentes em todas as situa\u00e7\u00f5es acima, mas em nosso caso, a possibilidade de Bronquiectasia por inala\u00e7\u00e3o de g\u00e1s am\u00f4nia foi a mais prov\u00e1vel pelo fato da paciente ser assintom\u00e1tica antes da exposi\u00e7\u00e3o ocupacional ao vazamento e consequente inala\u00e7\u00e3o de g\u00e1s am\u00f4nia no ambiente de trabalho, sem hist\u00f3ria pr\u00e9via de asma ou qualquer outro sintoma pulmonar.<\/p>\n<p><strong>Quest\u00e3o 02: Quais as conseq\u00fc\u00eancias agudas e cr\u00f4nicas da les\u00e3o pulmonar causada pela Inala\u00e7\u00e3o de g\u00e1s am\u00f4nia?<\/strong><\/p>\n<p>(a) \u2013 Traqueobronquite<br \/>\n(b) \u2013 Insufici\u00eancia Respirat\u00f3ria<br \/>\n(c) \u2013 hiperreatividade bronquica<br \/>\n(d) \u2013 Edema pulmonar<br \/>\n(e) \u2013 Todas acima<\/p>\n<p><strong> Discuss\u00e3o<\/strong><\/p>\n<p>A am\u00f4nia \u00e9 um produto b\u00e1sico na ind\u00fastria qu\u00edmica e tem aplica\u00e7\u00f5es dom\u00e9sticas e industriais. Na ind\u00fastria, a am\u00f4nia \u00e9 usada no refino de petr\u00f3leo, como insumo na fabrica\u00e7\u00e3o de produtos farmac\u00eauticos e como g\u00e1s refrigerante nos processos de resfriamento de c\u00e2maras frigor\u00edficas e ar condicionado industrial. Na agricultura, a am\u00f4nia pode ser usada na fabrica\u00e7\u00e3o de fertilizantes.<\/p>\n<p>A am\u00f4nia tamb\u00e9m pode ser produzida naturalmente quando os materiais armazenados como esterco, compostagem e outros materiais org\u00e2nicos se decomp\u00f5em. \u00c9 considerada um produto qu\u00edmico perigoso, corrosivo para a pele, olhos, vias a\u00e9reas superiores e pulm\u00f5es. Quando inalada, o nariz \u00e9 geralmente o primeiro a sentir os sintomas da exposi\u00e7\u00e3o. Pode causar tosse, chiado no peito, falta de ar, asfixiar e queimar as vias a\u00e9reas superiores e inferiores. O g\u00e1s am\u00f4nia, a temperatura ambiente, \u00e9 um g\u00e1s incolor com odor pungente e sufocante; em altas press\u00f5es, transforma-se em l\u00edquido facilitando o transporte e armazenamento; \u00e9 altamente hidrossol\u00favel, sendo rapidamente absorvido pelas membranas mucosas e pele e reage com \u00e1gua para forma de hidr\u00f3xido de am\u00f4nia, o qual \u00e9 potencialmente irritante e c\u00e1ustico, causando les\u00e3o qu\u00edmica+ rea\u00e7\u00e3o exot\u00e9rmica (queimadura) (figura 5 ). Quanto aos efeitos da exposi\u00e7\u00e3o aguda sobre a pele e mucosas como nariz, olhos, garganta e\/ou sistema respirat\u00f3rio superior,tosse, prurido e queimaduras; pode ocorrer descama\u00e7\u00e3o da camada epitelial dos br\u00f4nquios, causando traqueobronquite; Quanto \u00e0 exposi\u00e7\u00f5es cr\u00f4nicas repetidas, podem levar a les\u00f5es em pulm\u00e3o, nariz e olhos.H\u00e1 relatos de hiperreatividade das vias a\u00e9reas associada a inflama\u00e7\u00e3o br\u00f4nquica cr\u00f4nica. Existem alguns relatos de casos de bronquiectasia p\u00f3s inala\u00e7\u00e3o intensa de am\u00f4nia, onde dois pacientes ( 22 e 20 anos) que inalaram grande quantidade de am\u00f4nia ap\u00f3s acidente de trem, foram hospitalizados agudamente, e em reavalia\u00e7\u00e3o ap\u00f3s 3 anos desenvolveram bronquiectasias e dist\u00farbio pulmonar ventilat\u00f3rio obstrutivo.<\/p>\n<p style=\"text-align: center\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-9088\" src=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_05.jpg\" alt=\"\" width=\"550\" height=\"298\" srcset=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_05.jpg 550w, https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_05-300x163.jpg 300w\" sizes=\"auto, (max-width: 550px) 100vw, 550px\" \/><\/p>\n<p style=\"text-align: center\">Figura 05<\/p>\n<p><strong>Bibliografia<\/strong><\/p>\n<ol>\n<li>Leduc D.et al,Thorax. 1992 Sep;47(9):755-7.<\/li>\n<li>White CE.et al.J Burn Care Res. 2007 Nov-Dec;28(6):922-8. Review.<\/li>\n<\/ol>\n<p><strong>Respostas corretas:<\/strong> 1b; 2e<\/p>\n<!-- AddThis Advanced Settings generic via filter on the_content --><!-- AddThis Share Buttons generic via filter on the_content -->","protected":false},"excerpt":{"rendered":"<p>Autores Lilian s Ballini Caetano M\u00e9dica Assistente da Disciplina de Pneumologia da EPM\/Unifesp Samir Drackoulakis Doutor em Medicina pela Disciplina de Pneumologia da EPM\/Unifesp Ana Carolina Terra Cruz Residente de Pneumologia da Disciplina de Pneumologia da EPM\/Unifesp Relato do caso SCM, feminina, 39 anos, branca, natural e procedente de S\u00e3o Paulo. Chiado no peito h\u00e1 [&hellip;]<!-- AddThis Advanced Settings generic via filter on get_the_excerpt --><!-- AddThis Share Buttons generic via filter on get_the_excerpt --><\/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":[15,217],"tags":[],"class_list":["post-9083","post","type-post","status-publish","format-standard","hentry","category-acesso-restrito","category-casos-clinicos-2018"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Caso cl\u00ednico - Janeiro 2018 - 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-janeiro-2018\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Caso cl\u00ednico - Janeiro 2018 - sbpt.org.br\" \/>\n<meta property=\"og:description\" content=\"Autores Lilian s Ballini Caetano M\u00e9dica Assistente da Disciplina de Pneumologia da EPM\/Unifesp Samir Drackoulakis Doutor em Medicina pela Disciplina de Pneumologia da EPM\/Unifesp Ana Carolina Terra Cruz Residente de Pneumologia da Disciplina de Pneumologia da EPM\/Unifesp Relato do caso SCM, feminina, 39 anos, branca, natural e procedente de S\u00e3o Paulo. Chiado no peito h\u00e1 [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/\" \/>\n<meta property=\"og:site_name\" content=\"sbpt.org.br\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/pneumosbpt\" \/>\n<meta property=\"article:published_time\" content=\"2018-02-02T15:29:04+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-03-05T18:27:35+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/sbpt.org.br\/portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_01.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"400\" \/>\n\t<meta property=\"og:image:height\" content=\"256\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Paulo Campos\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pneumosbpt\" \/>\n<meta name=\"twitter:site\" content=\"@pneumosbpt\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Paulo Campos\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/\"},\"author\":{\"name\":\"Paulo Campos\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#\\\/schema\\\/person\\\/25d1c6e4a25f0333d9e675d8043837f6\"},\"headline\":\"Caso cl\u00ednico &#8211; Janeiro 2018\",\"datePublished\":\"2018-02-02T15:29:04+00:00\",\"dateModified\":\"2026-03-05T18:27:35+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/\"},\"wordCount\":925,\"publisher\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/d1xe7tfg0uwul9.cloudfront.net\\\/sbpt-portal\\\/wp-content\\\/uploads\\\/2018\\\/02\\\/caso01_jan18_01.jpg\",\"articleSection\":[\"Acesso Restrito\",\"Casos Cl\u00ednicos \u2013 2018\"],\"inLanguage\":\"pt-BR\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/\",\"url\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/\",\"name\":\"Caso cl\u00ednico - Janeiro 2018 - sbpt.org.br\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/d1xe7tfg0uwul9.cloudfront.net\\\/sbpt-portal\\\/wp-content\\\/uploads\\\/2018\\\/02\\\/caso01_jan18_01.jpg\",\"datePublished\":\"2018-02-02T15:29:04+00:00\",\"dateModified\":\"2026-03-05T18:27:35+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/#breadcrumb\"},\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-BR\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/#primaryimage\",\"url\":\"https:\\\/\\\/d1xe7tfg0uwul9.cloudfront.net\\\/sbpt-portal\\\/wp-content\\\/uploads\\\/2018\\\/02\\\/caso01_jan18_01.jpg\",\"contentUrl\":\"https:\\\/\\\/d1xe7tfg0uwul9.cloudfront.net\\\/sbpt-portal\\\/wp-content\\\/uploads\\\/2018\\\/02\\\/caso01_jan18_01.jpg\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/caso-clinico-janeiro-2018\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Caso cl\u00ednico &#8211; Janeiro 2018\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#website\",\"url\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/\",\"name\":\"sbpt.org.br\",\"description\":\"Sociedade Brasileira de Pneumologia e Tisiologia\",\"publisher\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#organization\"},\"alternateName\":\"SBPT\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"pt-BR\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#organization\",\"name\":\"sbpt.org.br\",\"url\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-BR\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/wp-content\\\/uploads\\\/2026\\\/10\\\/logo-sbpt.png\",\"contentUrl\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/wp-content\\\/uploads\\\/2026\\\/10\\\/logo-sbpt.png\",\"width\":512,\"height\":512,\"caption\":\"sbpt.org.br\"},\"image\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/pneumosbpt\",\"https:\\\/\\\/x.com\\\/pneumosbpt\",\"https:\\\/\\\/www.linkedin.com\\\/company\\\/pneumosbpt\\\/\",\"https:\\\/\\\/www.instagram.com\\\/pneumosbpt\\\/\",\"https:\\\/\\\/www.youtube.com\\\/user\\\/socbraspneumol\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#\\\/schema\\\/person\\\/25d1c6e4a25f0333d9e675d8043837f6\",\"name\":\"Paulo Campos\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-BR\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/68136167da57c9f55271c7cedabfa948fa7cf47517ec6429c6ae3f6a2c732f45?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/68136167da57c9f55271c7cedabfa948fa7cf47517ec6429c6ae3f6a2c732f45?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/68136167da57c9f55271c7cedabfa948fa7cf47517ec6429c6ae3f6a2c732f45?s=96&d=mm&r=g\",\"caption\":\"Paulo Campos\"},\"url\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/author\\\/paulo\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Caso cl\u00ednico - Janeiro 2018 - sbpt.org.br","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/","og_locale":"pt_BR","og_type":"article","og_title":"Caso cl\u00ednico - Janeiro 2018 - sbpt.org.br","og_description":"Autores Lilian s Ballini Caetano M\u00e9dica Assistente da Disciplina de Pneumologia da EPM\/Unifesp Samir Drackoulakis Doutor em Medicina pela Disciplina de Pneumologia da EPM\/Unifesp Ana Carolina Terra Cruz Residente de Pneumologia da Disciplina de Pneumologia da EPM\/Unifesp Relato do caso SCM, feminina, 39 anos, branca, natural e procedente de S\u00e3o Paulo. Chiado no peito h\u00e1 [&hellip;]","og_url":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/","og_site_name":"sbpt.org.br","article_publisher":"https:\/\/www.facebook.com\/pneumosbpt","article_published_time":"2018-02-02T15:29:04+00:00","article_modified_time":"2026-03-05T18:27:35+00:00","og_image":[{"width":400,"height":256,"url":"https:\/\/sbpt.org.br\/portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_01.jpg","type":"image\/jpeg"}],"author":"Paulo Campos","twitter_card":"summary_large_image","twitter_creator":"@pneumosbpt","twitter_site":"@pneumosbpt","twitter_misc":{"Escrito por":"Paulo Campos","Est. tempo de leitura":"5 minutos"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/#article","isPartOf":{"@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/"},"author":{"name":"Paulo Campos","@id":"https:\/\/sbpt.org.br\/portal\/#\/schema\/person\/25d1c6e4a25f0333d9e675d8043837f6"},"headline":"Caso cl\u00ednico &#8211; Janeiro 2018","datePublished":"2018-02-02T15:29:04+00:00","dateModified":"2026-03-05T18:27:35+00:00","mainEntityOfPage":{"@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/"},"wordCount":925,"publisher":{"@id":"https:\/\/sbpt.org.br\/portal\/#organization"},"image":{"@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/#primaryimage"},"thumbnailUrl":"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_01.jpg","articleSection":["Acesso Restrito","Casos Cl\u00ednicos \u2013 2018"],"inLanguage":"pt-BR"},{"@type":"WebPage","@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/","url":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/","name":"Caso cl\u00ednico - Janeiro 2018 - sbpt.org.br","isPartOf":{"@id":"https:\/\/sbpt.org.br\/portal\/#website"},"primaryImageOfPage":{"@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/#primaryimage"},"image":{"@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/#primaryimage"},"thumbnailUrl":"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_01.jpg","datePublished":"2018-02-02T15:29:04+00:00","dateModified":"2026-03-05T18:27:35+00:00","breadcrumb":{"@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/#breadcrumb"},"inLanguage":"pt-BR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/"]}]},{"@type":"ImageObject","inLanguage":"pt-BR","@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/#primaryimage","url":"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_01.jpg","contentUrl":"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/02\/caso01_jan18_01.jpg"},{"@type":"BreadcrumbList","@id":"https:\/\/sbpt.org.br\/portal\/caso-clinico-janeiro-2018\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/sbpt.org.br\/portal\/"},{"@type":"ListItem","position":2,"name":"Caso cl\u00ednico &#8211; Janeiro 2018"}]},{"@type":"WebSite","@id":"https:\/\/sbpt.org.br\/portal\/#website","url":"https:\/\/sbpt.org.br\/portal\/","name":"sbpt.org.br","description":"Sociedade Brasileira de Pneumologia e Tisiologia","publisher":{"@id":"https:\/\/sbpt.org.br\/portal\/#organization"},"alternateName":"SBPT","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/sbpt.org.br\/portal\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"pt-BR"},{"@type":"Organization","@id":"https:\/\/sbpt.org.br\/portal\/#organization","name":"sbpt.org.br","url":"https:\/\/sbpt.org.br\/portal\/","logo":{"@type":"ImageObject","inLanguage":"pt-BR","@id":"https:\/\/sbpt.org.br\/portal\/#\/schema\/logo\/image\/","url":"https:\/\/sbpt.org.br\/portal\/wp-content\/uploads\/2026\/10\/logo-sbpt.png","contentUrl":"https:\/\/sbpt.org.br\/portal\/wp-content\/uploads\/2026\/10\/logo-sbpt.png","width":512,"height":512,"caption":"sbpt.org.br"},"image":{"@id":"https:\/\/sbpt.org.br\/portal\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/pneumosbpt","https:\/\/x.com\/pneumosbpt","https:\/\/www.linkedin.com\/company\/pneumosbpt\/","https:\/\/www.instagram.com\/pneumosbpt\/","https:\/\/www.youtube.com\/user\/socbraspneumol"]},{"@type":"Person","@id":"https:\/\/sbpt.org.br\/portal\/#\/schema\/person\/25d1c6e4a25f0333d9e675d8043837f6","name":"Paulo Campos","image":{"@type":"ImageObject","inLanguage":"pt-BR","@id":"https:\/\/secure.gravatar.com\/avatar\/68136167da57c9f55271c7cedabfa948fa7cf47517ec6429c6ae3f6a2c732f45?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/68136167da57c9f55271c7cedabfa948fa7cf47517ec6429c6ae3f6a2c732f45?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/68136167da57c9f55271c7cedabfa948fa7cf47517ec6429c6ae3f6a2c732f45?s=96&d=mm&r=g","caption":"Paulo Campos"},"url":"https:\/\/sbpt.org.br\/portal\/author\/paulo\/"}]}},"_links":{"self":[{"href":"https:\/\/sbpt.org.br\/portal\/wp-json\/wp\/v2\/posts\/9083","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sbpt.org.br\/portal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sbpt.org.br\/portal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sbpt.org.br\/portal\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/sbpt.org.br\/portal\/wp-json\/wp\/v2\/comments?post=9083"}],"version-history":[{"count":0,"href":"https:\/\/sbpt.org.br\/portal\/wp-json\/wp\/v2\/posts\/9083\/revisions"}],"wp:attachment":[{"href":"https:\/\/sbpt.org.br\/portal\/wp-json\/wp\/v2\/media?parent=9083"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sbpt.org.br\/portal\/wp-json\/wp\/v2\/categories?post=9083"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sbpt.org.br\/portal\/wp-json\/wp\/v2\/tags?post=9083"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}