DISCUSSION: This illustrates a rare case of primary parotid ACC with metastasis to the lungs. Typically, these tumors present as slow growing masses, most often localized to the parotid. Distant metastasis only rarely occurs, and there have been case reports of ACC metastasizing to lung and bone. Metastatic ACC carries a poor prognosis with 5-year survival rates of less than 50%, thus highlighting the importance of identifying these cancers early in their disease course. To our knowledge, this is the first case report of metastatic ACC being diagnosed with EBUS. Given the high mortality rate of metastatic ACC, the identification of metastatic disease to the lung can change the course of treatment if found early in the disease process.