CLINICAL IMAGE
An 85-year-old man with a 2-day history of dyspnea and general malaise
was admitted to our hospital with hypopnea and acidosis. Chest
radiograph and CT scan identified a round high-density shadow about 1cm
in diameter (Figure 1). We deduced that a pachinko-ball (Pachinko is a
Japanese pinball gambling game) obstructed the right inferior lobar
bronchus. Forced coughing and back blow failed to remove it. To remove
the obstacle with minimal invasion, we considered several devices with
an endoscope under mechanical ventilation; a magnet, a basket type or a
pentatope type grasping forceps, or an endoscopic net forceps, with the
support of a laryngeal mask airway, which we selected. The pachinko ball
was successfully retrieved without severe damage to the patient (Figure
2). The patient received non-invasive positive-pressure ventilation for
one day and antibiotic administration for 14 days. Rehabilitation
improved his general condition, and he was transferred to a long-term
hospital on day 48. There is no consensus on how to retrieve a metallic
round ball from an airway. Based on our experience, we propose that
endoscopic net forceps with the support of a laryngeal mask airway is a
dependable choice for such occasions.
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