Endobronchial Ultrasound (EBUS)

What is an endobronchial ultrasound (EBUS)?

An endobronchial ultrasound (EBUS) is a medical imaging procedure that allows a healthcare provider to get pictures of the inside of your lungs. It’s a form of bronchoscopy — a procedure that uses a thin, lighted tube to look inside your lungs — where the bronchoscope has an ultrasound machine attached to it.

Providers use EBUS to diagnose lung conditions and stage cancer. Providers can also use other tools with the bronchoscope in the same procedure, allowing them to get samples for biopsies at the same time.

Types of endobronchial ultrasound

The types of endobronchial ultrasound include:

• Radial probe EBUS (RP-EBUS). An RP-EBUS gives a high-definition, 360-degree view of the inside of your airways. It can go farther into your lungs and give better detail than a convex probe EBUS, but if a provider needs a biopsy, they need to use separate equipment to get it.
• Convex probe EBUS (CP-EBUS). A CP-EBUS can be only used in your large airways (trachea and bronchi). Its advantage is that the provider can also get a biopsy at the same time, if needed. It has a more limited, less detailed view than the RP-EBUS.
• EBUS-transbronchial needle aspiration (EBUS-TBNA). Providers use EBUS-TBNA to take samples of tissue or fluid for biopsy during a convex probe EBUS.

What’s the difference between bronchoscopy and EBUS?

An EBUS is a specific type of bronchoscopy. Providers can use a bronchoscope — the device used during bronchoscopy — to look at your lungs with a camera or get samples of fluid or tissues from inside your lungs. During EBUS, a healthcare provider uses a bronchoscope to get ultrasound images of the inside of your lungs. They sometimes get samples for biopsies during the same procedure.

Why would you need an EBUS?

Healthcare providers use EBUS when they need to get a more detailed look at something they saw on an X-ray or CT scan. They can use it to diagnose:

• Lung infections and abscesses.
• Cancer in your lungs or the space between your lungs (mediastinum).
• Sarcoidosis, silicosis or other inflammatory lung conditions.
• Airway narrowing (stenosis).
• Pulmonary nodules.

Providers also can use EBUS to stage some cancers.

How does an endobronchial ultrasound work?

A pulmonologist performs an EBUS. They use a thin, lighted tube (bronchoscope) to look in your airways — the passages that bring air into and out of your lungs. An ultrasound device is attached to the bronchoscope. The ultrasound uses sound waves to send detailed images of the insides of your lungs to a screen where your provider can view them. The provider can guide the bronchoscope to the area they want to look at to see it in more detail.

How do I prepare for an EBUS?

Your healthcare provider will give you instructions on how to prepare for your EBUS. Ask your provider if any of the instructions are unclear. You may need to:

• Get bloodwork before the procedure.
• Not eat or drink anything (fast) for a certain amount of time before the procedure.
• Stop taking certain medications before the procedure. Tell your provider about any medications, including supplements, that you’re taking.
• Arrange for someone to take you home after the procedure. You won’t be able to drive yourself after being sedated.

What should I expect during an endobronchial ultrasound?

Before the procedure, you’ll lie down on a bed or table. Providers will:

• Help you get into the right position if they need to.
• Insert an intravenous (IV) into your arm. A nurse anesthetist or an anesthesiologist will give you medication through the IV to keep you comfortable throughout the procedure. You might be moderately sedated or under general anesthesia for an EBUS. Ask your provider what to expect.
• Numb your mouth (or nose) and throat with a spray.

When you’re sedated and numb, a pulmonologist will:

1. Insert the bronchoscope through your nose or mouth.
2. Navigate through your airways to the area they want to look at.
3. Take samples for biopsies if they need to.
4. Gently remove the bronchoscope.

How long does an endobronchial ultrasound take?

An EBUS takes anywhere from 30 to 90 minutes. Ask your provider how long they think it’ll take in your specific case. You’ll need to wait an hour or two before you can go home after the procedure.

Is EBUS biopsy painful?

As providers use anesthesia, you shouldn’t feel pain during the procedure. You may have a sore throat, cough or hoarseness for about a day or so afterward. But if you’re in pain, contact your provider right away.

What should I expect after an endobronchial ultrasound?

You can usually go home within a couple of hours after the procedure. Your healthcare team will monitor you until you’re fully awake and breathing and swallowing well. They can let you know when you should expect any test results and when you should schedule a follow-up appointment.

For about a day afterward, you might:

• Have a sore throat.
• Have a hoarse voice.
• Cough.

Coughing up a little bit of blood after the procedure is normal and should go away within a few hours or days. But let your provider know if it doesn’t go away within a few days or if you’re coughing up a lot of blood.

What are the risks of an EBUS?

While EBUS is a very low-risk procedure. But in rare cases, complications can happen. These include:

• Bleeding.
• Infection.
• Collapsed lung.
• Respiratory depression (not clearing carbon dioxide out of your body) or other breathing issues.

What are the benefits of an endobronchial ultrasound?

Compared to other forms of imaging and biopsy, EBUS has several benefits, including:

• Providers can use the bronchoscope to position the ultrasound exactly where they need it to get the images they want.
• A provider can do a biopsy and imaging at the same time rather than in two different procedures. It can also sometimes be used to diagnose and stage cancer at the same time.
• It’s an outpatient procedure. This means you don’t have to be admitted to the hospital and you go home the same day.
• It’s minimally invasive. This means there’s less risk than other procedures, where your provider has to make an incision (cut through your skin).

What type of results do you get after an EBUS and what do the results mean?

If you had a sample of tissue or fluid taken as part of your EBUS, your provider might have it tested for infections, cancer or other conditions, depending on your situation. Your provider can explain any results and what your next steps are.

When should I call my healthcare provider?

Contact your provider if you have any questions or unexpected side effects. Seek medical attention right away if you have signs of an infection, including:

• Fever.
• Chest pain.
• Difficulty breathing.
• Difficulty swallowing.
• Persistent coughing up blood.
• Being unable to pee (urinate).

A note from Cleveland Clinic

An endobronchial ultrasound (EBUS) is a minimally invasive, outpatient procedure. It allows your provider to get a close, detailed look at changes in your lungs. They can also use it to get tissue and fluid samples with less risk than other procedures. Don’t hesitate to ask your healthcare provider if you have any questions about how the procedure works, what they’re looking for or when you’ll hear from them. Knowing what to expect can help put your mind at ease.