A 78-year-old female woke up with difficulty breathing and has fine crackles in her bases. What condition should you consider?

In this scenario, the presence of fine crackles in the lung bases along with the patient's age and sudden onset of difficulty breathing suggest pulmonary edema as a likely condition.

Pulmonary edema occurs when fluid accumulates in the lungs, often due to heart failure or other cardiovascular issues. The fine crackles, also known as rales, indicate fluid present in the small airways, which is characteristic of pulmonary edema. The patient's age also plays a role, as older adults are at a higher risk for heart-related conditions that can lead to pulmonary edema.

While pneumonia could also cause difficulty breathing and crackles, it often presents with additional signs such as fever, productive cough, and more localized lung findings that weren't mentioned in this case. Portal hypertension typically involves gastrointestinal symptoms and is less likely to manifest primarily as respiratory distress. Pleurisy usually produces a pleuritic chest pain and may cause a different type of breath sound, often more focused on the pleural space rather than fine crackles throughout the lung bases.

Thus, the combination of sudden breathing difficulty, age, and the clinical finding of fine crackles points strongly toward pulmonary edema as the condition that should be considered.