Learnings from the case

The most important take home messages of the case are:
  1. A normal FVC does not exclude the diagnosis of pulmonary fibrosis.
  2. The presence of velcro crackles is highly suspicious of an underlying fibrotic disease and should prompt for further investigation with HRCT.
  3. The presence of digital clubbing in a smoker imperatively renders the exclusion of an underlying malignancy.