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Analysis of chest roentgenograms performed before spontaneous fragmentation and distal embolization of an implanted subclavian vein catheter revealed discontinuity of the catheter's radiopaque marker in addition to kinking of the area proximal to the breakage point. To the authors' knowledge the case presented in this article is the first report of this imaging sign before catheter fragmentation. Lateral catheter placement and early recognition of subtle imaging signs may assist in decreasing the incidence of this significant complication.

Adult respiratory distress syndrome, presenting as rapid respiratory decompensation in the setting of preeclampsia at 36 weeks of gestation, was managed by early hemodynamic monitoring with pulmonary artery catheterization. With confirmation of the diagnosis of preeclampsia the patient was delivered promptly; improvement of her respiratory failure was observed within 48 hours. Consideration of adult respiratory distress syndrome in the setting of preeclampsia is discussed, with emphasis on early confirmation of the diagnosis and determination of the precise mechanisms of pulmonary edema.

We describe a case of hemolysis, elevated liver enzymes and low platelet count (HELLP syndrome) at 38 weeks' gestation. This condition was diagnosed when the patient presented with acute, persistent gum bleeding after toothbrushing. Her platelet count was 26,000/mm3. Bleeding gums have rarely led to the diagnosis of this syndrome; this case appears to be the most severe description of this clinical presentation following toothbrushing yet presented in the literature. Although the patient had been hospitalized 48 hours earlier with nonspecific viral-like symptoms, she was discharged after being treated with intravenous hydration. Reexamination of laboratory studies obtained at the time of her first presentation revealed thrombocytopenia. The diagnosis of this syndrome could possibly have been made at that time. This case emphasizes the importance of maintaining a low threshold of suspicion for this syndrome.