Fluid in lungs--does it HAVE to start in bases?

angeloublue22, BSN, RN · Jan 22, 2018

Fluid will settle on the bottom due to gravity. If they hanging upside down then it may start at the top. Just being funny there. Not to say that is never happens because weird unexpected stuff always happens in healthcare but that is the general place is usually starts. Also you may hear it at the top if they have a lung injury and are missing a lobe. It sounds you have the right thought process though.

vanilla bean · Jan 23, 2018

I just thought of something as I was reading my text. It talks about how a manifestation of pulmonary edema is "auscultation of crackles in the lung bases." This made me wonder...and it may be a dumb question...can you auscultate crackles in the TOP lobes and have clear bottom lobes? That is, does fluid HAVE to accumulate in the bottom lobes before it can be present in the top lobes, due to gravity? THANKS SO MUCH.

Because your textbook was mentioning the presence of crackles in the context of pulmonary edema, then the answer is yes, gravity will cause the fluid to accumulate in the bases first and that is where you are more likely to hear crackles. In marked pulmonary edema, you are likely to hear crackles throughout the lung fields.

But, keep in mind that there are multiple causes of crackles (besides pulmonary edema), so it *is* possible to hear crackles in another lung field and not in the bases. For example, if a patient has a pneumonia or atelectasis in another lung field, you may only hear crackles in the affected area.

bgxyrnf, MSN, RN · Jan 25, 2018

The vast majority of patients are sitting up, at least 30 degrees, during hospitalization and when their lungs are auscultated. Hence, crackles in the bases. However, you can have crackles in other fields, or all fields.