Case overview

A 74-year-old male patient presented with progressive exertional dyspnoea for 5 years, non-productive cough and bilateral velcro-like crackles with basal predominance on auscultation. Functional tests showed a obstructive as well as an restrictive pattern. HRCT revealed a definite UIP pattern with concomitant paraseptal emphysema.
This diagnostic case is an example of normal FVC values not excluding a diagnosis of pulmonary fibrosis. The presence of velcro crackles is a specific indicator of an underlying fibrotic disease and should prompt for further investigation with HRCT.