Finger clubbing and COPD

This 73 year old patient with CPA in right upper lobe and COPD who was also a heavy smoker, showed evidence of finger clubbing ( A,B,C). He has been on long term itraconazole, in 1990 he had an oesophagectomy for cancer of the oesophagus. Finger clubbing is an uncommon symptom only seen in advanced or chronic disease. D, chest X ray there are background changes nof COPD with loss of volume in the right hemithorax and a right apical cavititating lesion.