A 40 year old male presented to casualty with severe pain in the left upper abdomen radiating to groin. Urine routine shows 6-8 pus cells and 15-20 RBCs . CT scan was taken. What is the diagnosis?
**Core Concept**
The patient's symptoms and laboratory results are suggestive of a urinary tract infection (UTI) with possible extension to the perinephric space, leading to a diagnosis of pyelonephritis or perinephric abscess. The presence of severe pain radiating to the groin, along with urinary findings of pus cells and RBCs, indicates possible involvement of the renal and ureteral structures.
**Why the Correct Answer is Right**
The patient's symptoms are consistent with pyelonephritis or perinephric abscess, which is an infection of the perinephric space surrounding the kidney. This condition often arises from a bacterial infection of the kidney (pyelonephritis) that spreads to the surrounding tissues. The severe pain radiating to the groin is likely due to the involvement of the ureter and surrounding structures.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because it does not accurately describe the patient's condition. While renal colic can cause severe pain, it is typically associated with a kidney stone rather than a urinary tract infection.
* **Option B:** This option is incorrect because it does not account for the presence of pus cells and RBCs in the urine, which suggests a bacterial infection.
* **Option C:** This option is incorrect because it does not accurately describe the patient's condition. While a perinephric hematoma can cause severe pain, it is typically associated with trauma or bleeding rather than a urinary tract infection.
**Clinical Pearl / High-Yield Fact**
In patients presenting with severe abdominal pain and urinary findings suggestive of a UTI, always consider the possibility of pyelonephritis or perinephric abscess, especially if the pain radiates to the groin.
**Correct Answer:** C.