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2023-07-18T16:56:05Z2023-07-18T16:56:05Z201626https://dx.doi.org/10.5935/2238-3182.201600942238-3182http://hdl.handle.net/1843/56595https://orcid.org/0000-0002-6621-3338https://orcid.org/0000-0001-9459-2294Apresenta um relato de caso de um paciente feminino, 53 anos de idade, ex-tabagista, com diabetes mellitus e doença cardiovascular hipertensiva sistêmica, admitida no Hospital das Clínicas da Universidade Federal de Minas Gerais em decorrência de tosse oligoprodutiva, dispneia aos esforços moderados, febre baixa, e emagrecimento (2 kg) há 2 meses. A evolução subaguda de tosse, dispneia, febre e emagrecimento sugere tuberculose (TB) como possível diagnóstico, mas a pesquisa de BAAR no escarro foi negativa; entretanto, devido à sensibilidade relativamente baixa deste exame, requer a análise de pelo menos duas amostras para que seja garantida a confiabilidade adequada ao exame. As radiografias devem ser solicitadas para todo paciente com suspeita clínica de TB pulmonar. No entanto, até 15% dos casos de TB pulmonar não apresentam alterações radiológicas, o que é mais comum em pacientes imunossuprimidos. Em pacientes com baciloscopia positiva, este exame permite a exclusão de doença pulmonar associada, como câncer de pulmão em fumantes. A TCAR não está indicada de rotina, mas é útil para o diagnóstico de TB pulmonar atípica ou extrapulmonar, frequente em pacientes infectados pelo VIH. Além disso, embora não seja específica de TB, a demonstração de nódulos centrolobulares associados ao padrão de “árvore em brotamento” sugere processo em atividade e auxilia no diagnóstico diferencial com alterações sequelares da doença.It presents a case report of a female patient, 53 years old, former smoker, with diabetes mellitus and systemic hypertensive cardiovascular disease, hospitalized at the Hospital das Clínicas of the Federal University of Minas Gerais due to oligoproductive cough, dyspnea on exertion moderate, low fever, and weight loss (2 kg) for 2 months. The subacute evolution of cough, dyspnea, fever and weight loss suggests tuberculosis (TB) as a possible diagnosis, but AFB research in sputum was negative; however, due to the relatively low sensitivity of this test, it requires the analysis of at least two samples to ensure proper test reliability. X-rays should be ordered for every patient with clinical suspicion of pulmonary TB. However, up to 15% of cases of pulmonary TB do not show radiological changes, which is more common in immunosuppressed patients. In patients with positive bacilloscopy, this test allows the exclusion of associated lung disease, such as lung cancer in smokers. HRCT is not routinely indicated, but it is useful for diagnosing atypical pulmonary or extrapulmonary TB, which is common in HIV-infected patients. Furthermore, although not specific to TB, the demonstration of centrilobular nodules associated with the “tree-in-bud” pattern suggests an active process and helps in the differential diagnosis with sequelae of the disease.porUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICARevista Médica de Minas GeraisRelatos de casosDiagnósticoTuberculose pulmonarTomografia computadorizada por raios XRadiografia torácicaTuberculoseRadiografiaTelerradiografiaTomografia computadorizada de alta resoluçãoCaso 21Case 21info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://rmmg.org/artigo/detalhes/2075Daniela de Souza BragaGustavo de Francisco CamposBárbara de Queiroz e BragagliaLuanna Silva Monteiro MenezesTeresa Cristina de Abreu Ferrariapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALCaso 21.pdfCaso 21.pdfapplication/pdf834685https://repositorio.ufmg.br/bitstream/1843/56595/2/Caso%2021.pdf41805509eb3ccbe0246450fbdd45d10bMD52LICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/56595/1/License.txtfa505098d172de0bc8864fc1287ffe22MD511843/565952023-07-18 13:56:06.022oai:repositorio.ufmg.br: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Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-07-18T16:56:06Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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