"Ropi"-Thorax as a Complication of Landmark-Based Paravertebral Pain Catheter Placement: A Case Report.

A 42-year-old female sustained multiple unilateral rib fractures and a hemopneumothorax following a motor vehicle collision. A paravertebral catheter was placed for analgesia; however, extensive subcutaneous emphysema obstructed ultrasound visualization, necessitating landmark‑guided placement. A continuous ropivacaine infusion produced excellent analgesia; however, the patient subsequently developed a pleural effusion. Computed tomography revealed a segment of the catheter migrated into the pleural cavity, resulting in inadvertent intrapleural local anesthetic infusion. This case highlights the limitations of landmark-based paravertebral catheter placement in the setting of distorted anatomy and underscores the need to consider catheter malposition when evaluating unexplained pleural effusions during continuous infusions.