Clubbing and dyspnea can be a presenting feature of telomere-mediated hepatopulmonary syndrome. (A) Image of digital clubbing typically seen. (B) Abdominal CT image showing liver with nodular edges (yellow arrowheads) and secondary splenomegaly due to portal hypertension. (C) The lymphocyte telomere length by flowFISH in older patients with short telomere syndrome presenting over age 60 overlaps with the lower decile of the normal range.