The patient has longstanding cyanotic heart disease.

Finger clubbing also called "drumstick fingers", is a common clinical sign in patients with heart or lung disease. The term is used to describe an enlargement of the distal phalanges of the fingers, giving them a drumstick or club-like appearance. 

It has a number of causes including pulmonary or cardiac diseases, gastrointestinal diseases, and thyrotoxicosis.

Finger clubbing is caused by increased proangiogenic factors including vascular endothelial growth factor which leads to tissue hypertrophy under the nail bed leading to elevation of the nail bed associated with soft tissue edema evaluated on MRI imaging.

This case is courtesy of Dr Ahmed Hossam.