EBUS (Endobronchial Ultrasound) test: How to look inside the lungs with a camera!

You too may have been told by a doctor about a lung test. Perhaps they saw something small on your ``(X-ray)`` or ``(CT scan)`` and said they needed to look into it further. In such cases, this is a special test called EBUS that is done to see exactly what is going on inside the lungs. Shall we talk more about this?

What is EBUS (endobronchial ultrasound)?

Simply put, EBUS (Endobronchial Ultrasound) is a procedure where a small camera-like device is inserted into your lungs to see what's inside them clearly. This is similar to a bronchoscopy. However, in this case, an ultrasound machine is also attached to the end of the bronchoscope. This means that the doctor can see what's inside your lungs as ultrasound images. Think of it like an ultrasound scan of a baby in the womb, which looks for tumors and lymph nodes in the lungs.

This method is used to detect various diseases in the lungs, especially to find out if there is cancer (`(Cancer)`) and how far it has spread (`(Staging)`). Another good thing is that during this EBUS test, if necessary, a piece of tissue can be taken and sent for a `(Biopsy)` test. Then you can do two things at once.

So what is the difference between `(Bronchoscopy)` and EBUS?

Good question! `(Bronchoscopy)` is the name given to the instrument (`(Bronchoscope)`) and the procedure commonly used to look inside the lungs. This allows doctors to see what's inside the lungs with a camera, or to take tissue samples (`(Biopsy sample)`) or fluid samples.

EBUS is also a `(Bronchoscopy)`. But the specialty is that in this `(Bronchoscope)`, `(Ultrasound)` capability is added . Therefore, even things like lymph nodes that are beyond the lung walls and cannot be seen with a normal `(Bronchoscope)` can be clearly seen with this EBUS. Also, it is a great help to take a `(Biopsy)` by looking at those `(Ultrasound)` images and sending a needle to the exact place.

Are there types of EBUS tests?

Yes, there are several main types of EBUS tests. A doctor chooses which type to perform based on what is needed at the time.

Radial Probe EBUS `(Radial Probe EBUS - RP-EBUS)`

This `(RP-EBUS)` can give you a very clear, 360-degree view of the inside of your airways . It can go much deeper into the lungs and get better detailed views than other types. However, if you need to take a `(Biopsy)`, you have to use separate equipment for that.

Convex Probe EBUS `(Convex Probe EBUS - CP-EBUS)`

This `(CP-EBUS)` can only be used on your main airways (i.e. the trachea and bronchi). This means that it cannot go deep into the lungs. However, the big advantage of this is that a `(Biopsy)` can be taken during the examination if necessary . However, the view obtained from this is a little more limited and less detailed than `(RP-EBUS)`.

EBUS-Transbronchial Needle Aspiration (EBUS-TBNA)

This is not a separate type. When performing a `(CP-EBUS)` test, the method used to take a sample of tissue (`(Tissue)`) or fluid (`(Fluid)`) for a `(Biopsy`)` is called `(EBUS-TBNA)`. To be precise, a small needle (`(Needle)`) is passed through the wall of the airway , using `(Ultrasound)`, and a sample is taken from the desired area.

When would you need an EBUS test?

Usually, a doctor will order an EBUS test if they see something unusual on your chest X-ray or CT scan to investigate it further. For example, a CT scan may show a small lump in your lung, or swollen lymph nodes. In such cases, an EBUS test can help determine exactly what it is.

The EBUS test is used to diagnose conditions such as:

• Lung infections and abscesses
• Lung cancer or cancer of the space between the lungs (mediastinum)
• Inflammatory lung conditions such as sarcoidosis and silicosis
• Airway stenosis (narrowing of the airways)
• Small lumps in the lungs (Pulmonary nodules)

In addition, the EBUS test is also used to determine the stage (`Cancer staging`) of some cancer conditions, that is, how far the cancer has spread.

How exactly does the EBUS test work?

This EBUS test is performed by a doctor who specializes in lung diseases (`(Pulmonologist)`). He inserts a thin, lighted tube (`(Bronchoscope)`) through your airways (`(Airways)`), either through your nose or mouth. The work is done using an `(Ultrasound)` device attached to the tip of this `(Bronchoscope)`.

Imagine, this `(Ultrasound)` uses sound waves to send clear pictures of what's inside your lungs to a monitor. The doctor can look at those pictures, point the `(Bronchoscope)` exactly where he wants to look, and examine that area in great detail. It works just like a `(Sonar)` system to find things under the sea.

How should I prepare for an EBUS test?

Your doctor or hospital staff will give you instructions on how to prepare for your EBUS test. If there is anything unclear in the instructions, be sure to ask again. Typically, you will need to do the following:

• You may be asked to do some blood work before the test.
• You will be asked not to eat or drink anything for a few hours before the test (`(Fasting)`) . Usually you have to fast for about 6 to 8 hours.
• You may be asked to stop taking certain medications (such as blood thinners) a few days before the test. You should also tell your doctor about all medications you are taking, including any supplements you are taking.
• Find someone to drive you home after the test. You will be sedated, so you will not be able to drive after the test. It is essential to have someone with you.

What happens during the EBUS test? Will I feel pain?

Before the test, you will be made to lie down on a bed or table. Then:

Before the test

• If necessary, the nurses will help you stay upright.
• A small tube (`(Intravenous - IV)`) is inserted into a vein in your arm and a saline solution is given. This `(IV)` is where a nurse anesthetist or an anesthesiologist will give you the necessary medication. This medication will not make you feel any discomfort or pain until the test is over. Sometimes you will be given moderate sedation (`(Moderate sedation)`), or general anesthesia (`(General anesthesia)`) . Your doctor will tell you about this in advance.
• A numbing spray will be applied to your mouth (or nose) and throat. This will numb the area, so you won't feel any discomfort when the bronchoscope is inserted.

During the test

After making you forget and your throat is numb, the pulmonologist:

• The doctor will insert a bronchoscope through your nose or mouth.
• It takes it along the airways and directs it to where it needs to be looked at.
• If necessary, one or more biopsy samples will be taken.
• Then the bronchoscope is slowly removed.

You will not feel any pain during the test because you will be given anesthesia. However, you may experience a sore throat, coughing, or hoarseness for about a day after the test. Otherwise, if you experience severe pain, you should tell your doctor immediately.

How long does the EBUS test take?

An EBUS test usually takes between 30 and 90 minutes (about an hour and a half) . However, this time can vary depending on your condition. So ask your doctor how long it will take. After the test is over, you will still need to stay in the hospital for about an hour or two before you can go home.

What can you expect after an EBUS test?

You can usually go home a few hours after the test. The medical staff will look after you until you are fully awake, breathing well, and able to swallow. They will also tell you when you will get your test results and when you should see the doctor again.

The following may happen for about a day after the test:

• A sore throat
• A hoarse voice
• A cough

It's normal to cough up a little blood , and it will go away in a few hours or days. However, if it doesn't stop after a few days, or if there is a lot of blood, you should definitely inform your doctor .

Are there any risks with the EBUS test?

EBUS is a very low-risk procedure , but very rarely, some complications can occur. These include:

• Bleeding (`(Bleeding)`)
• Infection (`(Infection)`)
• Collapsed lung (or Pneumothorax) - This is when air from the lungs can leak into the chest cavity.
• Respiratory depression - This means breathing problems, such as the inability to properly exhale carbon dioxide from the body.

What are the benefits of the EBUS test?

Compared to other imaging methods and biopsy methods, EBUS has several advantages.

• The doctor can use the ``Bronchoscope'' and direct the ``Ultrasound'' to the exact location needed to obtain the desired images clearly.
• Taking a biopsy and taking pictures can both be done in the same test. There is no need to have two separate tests. Sometimes, it is possible to diagnose cancer and determine its stage at the same time.
• This is an outpatient procedure . This means you will not be kept in the hospital and you can go home the same day.
• This is a minimally invasive procedure . That means it doesn't have the same risks as open surgery. So you can recover quickly.

What are the results of the EBUS test? What do they mean?

If your EBUS test involves taking a piece of tissue or a sample of fluid, your doctor will send it to a lab to check for infection, cancer, or other conditions, depending on your condition. Your doctor will explain the results to you and tell you what to do next. You may need to wait a few days for the results to come back.

When should I see a doctor?

If you have any questions or unexpected side effects, talk to your doctor . You should especially seek medical advice immediately if you have any signs of infection. Such signs include:

• Fever (`(Fever)`)
• Chest pain (`(Chest pain)`)
• Difficulty breathing
• Difficulty swallowing
• Persistent coughing up blood
• Being unable to pee/urinate - Although this is not directly related to EBUS, it can sometimes happen after anesthesia, so it is important to mention it if it happens.

Finally, things to remember

EBUS (Endobronchial Ultrasound) is a minimally invasive, outpatient procedure that can provide a clear, detailed look at changes inside the lungs. It can also take tissue and fluid samples, with fewer risks than other methods.

Remember, don't hesitate to ask your doctor any questions you have about how the test is done, what the doctors are looking for, and when the results will be available. Knowing what to expect in advance will help reduce your anxiety. Stay healthy!

` EBUS, Endobronchial Ultrasound, Lung examination, Bronchoscopy, Ultrasound, Biopsy, Lung cancer, Respiratory diseases