diff --git a/dental-server/dental-client/public/version.txt b/dental-server/dental-client/public/version.txt
index 6a6199d..d4fe8d4 100644
--- a/dental-server/dental-client/public/version.txt
+++ b/dental-server/dental-client/public/version.txt
@@ -1 +1 @@
-2.1.63
+2.1.65
diff --git a/dental-server/dental-client/src/components/CreatePatientModal.jsx b/dental-server/dental-client/src/components/CreatePatientModal.jsx
index e59fef0..1d7c2be 100644
--- a/dental-server/dental-client/src/components/CreatePatientModal.jsx
+++ b/dental-server/dental-client/src/components/CreatePatientModal.jsx
@@ -14,8 +14,14 @@ export default function CreatePatientModal({ isOpen, onClose, onCreated }) {
     e.preventDefault();
     setSaving(true);
     try {
-      await api.post('/images/patients', form);
-      showToast('Paciente criado com sucesso!', 'success');
+      const response = await api.post('/images/patients', form);
+      if (response.data?.warning) {
+        showToast(response.data.warning, 'warning');
+      } else if (response.data?.message) {
+        showToast(response.data.message, 'success');
+      } else {
+        showToast('Paciente criado com sucesso!', 'success');
+      }
       setForm({ firstName: '', lastName: '', doctor: '', birthday: '', gender: '0', phone: '', remark: '' });
       onClose();
       onCreated?.();
diff --git a/dental-server/dental-client/src/components/EditPatientModal.jsx b/dental-server/dental-client/src/components/EditPatientModal.jsx
index d8bf0a1..76c83ff 100644
--- a/dental-server/dental-client/src/components/EditPatientModal.jsx
+++ b/dental-server/dental-client/src/components/EditPatientModal.jsx
@@ -25,8 +25,14 @@ export default function EditPatientModal({ isOpen, onClose, patient, onSaved })
     if (!form.newName.trim()) return showToast('Nome é obrigatório.', 'error');
     setSaving(true);
     try {
-      await api.put(`/images/patients/${encodeURIComponent(patient.patient_name)}`, form);
-      showToast('Paciente atualizado com sucesso!', 'success');
+      const response = await api.put(`/images/patients/${encodeURIComponent(patient.patient_name)}`, form);
+      if (response.data?.warning) {
+        showToast(response.data.warning, 'warning');
+      } else if (response.data?.message) {
+        showToast(response.data.message, 'success');
+      } else {
+        showToast('Paciente atualizado com sucesso!', 'success');
+      }
       onSaved?.();
       onClose();
     } catch (err) {
diff --git a/dental-server/dental-client/src/pages/DashboardPage.jsx b/dental-server/dental-client/src/pages/DashboardPage.jsx
index de89ae5..437ed07 100644
--- a/dental-server/dental-client/src/pages/DashboardPage.jsx
+++ b/dental-server/dental-client/src/pages/DashboardPage.jsx
@@ -253,8 +253,14 @@ export default function DashboardPage() {
     if (!confirm(`⚠️ Excluir permanentemente todas as imagens de "${patientName}"?\n\nEsta ação não pode ser desfeita.`)) return;
     showToast('Excluindo imagens do paciente...', 'info');
     try {
-      await api.delete(`/images/by-patient?name=${encodeURIComponent(patientName)}`);
-      showToast('✅ Todas as imagens foram excluídas!', 'success');
+      const response = await api.delete(`/images/by-patient?name=${encodeURIComponent(patientName)}`);
+      if (response.data?.warning) {
+        showToast(response.data.warning, 'warning');
+      } else if (response.data?.message) {
+        showToast(response.data.message, 'success');
+      } else {
+        showToast('✅ Todas as imagens foram excluídas!', 'success');
+      }
       loadPatients();
       loadClientsList();
     } catch (e) { showToast(e.response?.data?.error || 'Falha ao excluir.', 'error'); }
diff --git a/dental-server/dental-client/src/pages/PatientsPage.jsx b/dental-server/dental-client/src/pages/PatientsPage.jsx
index 444196b..40e49ef 100644
--- a/dental-server/dental-client/src/pages/PatientsPage.jsx
+++ b/dental-server/dental-client/src/pages/PatientsPage.jsx
@@ -83,8 +83,14 @@ export default function PatientsPage() {
   const deletePatient = async (patientName) => {
     if (!confirm(`⚠️ Excluir permanentemente todas as imagens de "${patientName}"?\n\nEsta ação não pode ser desfeita.`)) return;
     try {
-      await api.delete(`/images/by-patient?name=${encodeURIComponent(patientName)}`);
-      showToast('Paciente excluído com sucesso!', 'success');
+      const response = await api.delete(`/images/by-patient?name=${encodeURIComponent(patientName)}`);
+      if (response.data?.warning) {
+        showToast(response.data.warning, 'warning');
+      } else if (response.data?.message) {
+        showToast(response.data.message, 'success');
+      } else {
+        showToast('Paciente excluído com sucesso!', 'success');
+      }
       loadPatients(true);
     } catch (e) {
       showToast(e.response?.data?.error || 'Falha ao excluir.', 'error');
diff --git a/dental-server/package-lock.json b/dental-server/package-lock.json
index 597a8ad..77b9cf5 100644
--- a/dental-server/package-lock.json
+++ b/dental-server/package-lock.json
@@ -1,12 +1,12 @@
 {
   "name": "dental-image-server",
-  "version": "2.0.5",
+  "version": "2.1.4",
   "lockfileVersion": 3,
   "requires": true,
   "packages": {
     "": {
       "name": "dental-image-server",
-      "version": "2.0.5",
+      "version": "2.1.4",
       "license": "MIT",
       "dependencies": {
         "@aws-sdk/client-s3": "^3.1055.0",
diff --git a/dental-server/package.json b/dental-server/package.json
index 950f5c3..1a2df7c 100644
--- a/dental-server/package.json
+++ b/dental-server/package.json
@@ -1,6 +1,6 @@
 {
   "name": "dental-image-server",
-  "version": "2.1.3",
+  "version": "2.1.4",
   "description": "Servidor Socket.IO para receber e processar imagens dentais com interface web",
   "main": "server.js",
   "scripts": {
diff --git a/dental-server/routes/images.js b/dental-server/routes/images.js
index 2e6aeaa..678947c 100644
--- a/dental-server/routes/images.js
+++ b/dental-server/routes/images.js
@@ -2,10 +2,44 @@ const express = require('express');
 const router = express.Router();
 const db = require('../database');
 const imageProcessor = require('../image-processor');
+const crypto = require('crypto');
 const path = require('path');
 const fs = require('fs').promises;
 const storage = require('../storage');
 
+async function emitAndAwaitAck(io, action, payload) {
+  if (!io) return { success: true, warning: 'Socket.IO não inicializado no servidor.' };
+  
+  const eventId = crypto.randomUUID();
+  payload.eventId = eventId;
+  payload.action = action;
+  
+  const ackPromise = new Promise((resolve) => {
+    if (global.pendingAcks) {
+      global.pendingAcks.set(eventId, resolve);
+      setTimeout(() => {
+        if (global.pendingAcks.has(eventId)) {
+          global.pendingAcks.delete(eventId);
+          resolve(null); // Timeout
+        }
+      }, 4000);
+    } else {
+      resolve(null);
+    }
+  });
+
+  io.emit('remote-crud-patient', payload);
+  
+  const result = await ackPromise;
+  if (result && result.success) {
+    return { success: true, message: `Sincronizado com PC: ${result.pcName || 'Desconhecido'}`, ackInfo: result };
+  } else if (result && !result.success) {
+    return { success: true, warning: `Erro no app Windows (${result.pcName || 'Desconhecido'}): ${result.error || 'Erro local'}` };
+  } else {
+    return { success: true, warning: 'Salvo na nuvem, porém o App Windows não respondeu. Verifique se o PC está ligado e conectado.' };
+  }
+}
+
 // ================================================================
 // GET /api/images/unique-clients - Buscar lista leve de clínicas
 // ================================================================
@@ -217,7 +251,6 @@ router.post('/patients', async (req, res) => {
     const fullName = `${firstName || ''} ${lastName || ''}`.trim();
     if (!fullName) return res.status(400).json({ error: 'Nome obrigatório' });
 
-    const crypto = require('crypto');
     const dummyGuid = crypto.randomUUID();
 
     await db.run(
@@ -235,14 +268,11 @@ router.post('/patients', async (req, res) => {
     );
 
     const io = req.app.get('io') || global.io;
-    if (io) {
-      io.emit('remote-crud-patient', { 
-        action: 'create', 
-        patient: { id: dummyGuid, firstName, lastName, doctor, birthday, gender, phone, remark, fullName }
-      });
-    }
+    const syncResult = await emitAndAwaitAck(io, 'create', {
+      patient: { id: dummyGuid, firstName, lastName, doctor, birthday, gender, phone, remark, fullName }
+    });
 
-    res.json({ success: true, message: 'Paciente criado com sucesso' });
+    res.json(syncResult);
   } catch (error) {
     console.error('Erro ao criar paciente:', error);
     res.status(500).json({ error: error.message });
@@ -286,15 +316,12 @@ router.put('/patients/:name', async (req, res) => {
     );
 
     const io = req.app.get('io') || global.io;
-    if (io) {
-      io.emit('remote-crud-patient', { 
-        action: 'update', 
-        oldName: oldName,
-        patient: { newName: newName?.trim(), doctor, remark }
-      });
-    }
-
-    res.json({ success: true, updated: result.changes });
+    const syncResult = await emitAndAwaitAck(io, 'update', {
+      oldName: oldName,
+      patient: { newName: newName?.trim(), doctor, remark }
+    });
+    
+    res.json({ ...syncResult, updated: result.changes });
   } catch (error) {
     console.error('Erro ao editar paciente:', error);
     res.status(500).json({ error: error.message });
@@ -318,11 +345,9 @@ router.delete('/by-patient', async (req, res) => {
     await db.run('DELETE FROM images WHERE patient_name = $1', [patientName]);
 
     const io = req.app.get('io') || global.io;
-    if (io) {
-      io.emit('remote-crud-patient', { action: 'delete', patientName });
-    }
+    const syncResult = await emitAndAwaitAck(io, 'delete', { patientName });
 
-    res.json({ success: true, count: images.length });
+    res.json({ ...syncResult, count: images.length });
   } catch (error) {
     console.error('Erro ao excluir imagens do paciente:', error);
     res.status(500).json({ error: error.message });
diff --git a/dental-server/server.js b/dental-server/server.js
index e701a73..083bd0a 100644
--- a/dental-server/server.js
+++ b/dental-server/server.js
@@ -42,6 +42,10 @@ const io = socketIo(server, {
   maxHttpBufferSize: 5e7 // 50MB para suportar raios-x grandes
 });
 
+app.set('io', io);
+global.io = io;
+global.pendingAcks = new Map();
+
 const connectedClients = [];
 
 const PORT = process.env.PORT || 3000;
@@ -851,6 +855,15 @@ io.on('connection', (socket) => {
     }
   }, 1000);
 
+  // Ouvinte para receber confirmações do CRUD remoto
+  socket.on('remote-crud-ack', (data) => {
+    if (data && data.eventId && global.pendingAcks && global.pendingAcks.has(data.eventId)) {
+      const resolve = global.pendingAcks.get(data.eventId);
+      resolve(data);
+      global.pendingAcks.delete(data.eventId);
+    }
+  });
+
   // Identificação de clientes
   socket.on('client-identify', (data) => {
     console.log('👤 [client-identify] Evento recebido de:', socket.id);