EBUS or Endo-bronchial Ultrasound is an important investigation required for the diagnosis of thoracic/ lung problems. EBUS involves the standard protocol of fiberoptic bronchoscopy (FOB)- placement of the bronchoscope tube in the trachea to pass the probe for ultra-sound examination endo-bronchially i.e. from inside the lumen of the bronchial tree.

Ultrasound examination is thereafter used to guide the aspiration needle for fine-needle aspiration biopsy (FNAB) to obtain bronchial and trans-bronchial specimens for histo-pathological examination. Ultrasound guidance helps to correctly identify the structure to be biopsied. Instead of FOB, rigid bronchoscopy is sometimes preferred such as in case of children or an uncooperative patient for any other reason.

EBUS is required to diagnose the cause of a pathological lesion in the mediastinum i.e. the central space between the two lungs occupied by a large number of thoracic structures including the heart, great blood vessels, esophagus, lymph nodes and other tissues. FNAB is however done mostly from a solid lesion such as an enlarged lymph node or a tumor. FNAB is   helpful to differentiate between disease conditions such as tuberculosissarcoidosis or others. Conventional EBUS is mostly used to approach the central lesions in the mediastinum. Radial probes are used to approach the more peripheral lesions.

EBUS is frequently done as a day-care procedure although hospital admission may be required for patients with co-morbidities. It is mostly done under local anesthesia, but short general anesthesia may be done in case of any specific indication, especially when it is done with a rigid bronchoscope. It is a fairly safe procedure without any significant complication. Pre-EBUS assessment is necessary as for any other fiberoptic bronchoscopy procedure. Other than the clinical assessment of patient condition, investigations are required for cardiac status, bleeding parameters and serology for hepatitis, HIV infection and others as recommended. In patients with suspected co-morbidities, other investigations such as blood sugar levels, hepatic and renal function may also be necessary.

EBUS is a specialized endoscopic procedure which requires adequate experience and expertise. It is relatively costlier than the routine fiberoptic bronchoscopy because of the expensive equipment and other accessories. It should be done by the best interventional pulmonologist for best results at a specialized center.