On February 1, 2026, the NYT medical puzzle was a woman with abdominal pain. I gave Chat GPT 5.2 the first half of the article, then asked for a diagnosis. It gave one (the correct one.) I then gave Chat GPT the rest of the NYT, and Chat GPT provided a closely summary.
I provide links to the whole dialog and I also provide a summary of the story, below.
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NYT February 1, 2026
CASE STUDY LINK:
https://www.nytimes.com/2026/01/30/well/back-pain-pelvic-congestion-syndrome-nutcracker.html
This should be direct access to the AI dialog (Chat GPT 5.2):
https://chatgpt.com/share/697f8be2-e1dc-8005-b9f0-3927ae024c56
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This should be a link to the open-access full-text of the case:
https://bqwebpage.blogspot.com/2026/02/february-1-2026-nyt-diagnostic-dilemma.html
This below is a final short summary of the whole story, also written by AI.
Part 1 – Case Presentation: A 42-year-old pediatric ophthalmologist and mother of four developed sudden, exquisitely focal, deep “boring” pain just left of her spine that spread to the left flank and proved unrelenting despite extensive evaluations. Imaging and labs were unrevealing except for anemia; autoimmune, spinal, and gastrointestinal causes were excluded. Over months she developed nausea, heartburn, appetite loss, weight loss, and sleep disturbance, and she could not raise her arms without numbness. She had a long history of orthostatic lightheadedness and early varicose veins requiring compression stockings, but these new symptoms forced her to leave clinical practice.
Numerous specialists found nothing to unify the back pain, anemia, GI symptoms, and neurologic complaints.
Part 2 – Initial AI Diagnostic Impression:
The pattern suggested visceral or vascular rather than musculoskeletal pain, especially given the precise left paraspinal location corresponding to the left kidney and renal vessels. The combination of focal flank/back pain, anemia, venous symptoms, orthostatic intolerance, and systemic GI effects pointed toward a venous compression disorder, most notably nutcracker syndrome—compression of the left renal vein between the aorta and superior mesenteric artery—possibly in the setting of a connective-tissue/venous laxity phenotype. Associated pelvic venous congestion and even thoracic outlet–type symptoms could fit a broader vascular compression picture rather than isolated organ disease.
Part 3 – Case Resolution: Reviewing her records, the patient noticed repeated mentions of pelvic congestion syndrome and, researching further, learned about nutcracker syndrome as a cause of pelvic venous hypertension. An interventional radiologist friend reviewed her MRI and identified clear evidence of left renal vein compression. She underwent placement of a renal vein stent, after which her left flank and back pain resolved almost immediately, along with her nausea, reflux, and loss of appetite. Restored venous outflow relieved both renal and splanchnic congestion, and the diagnosis explained her earlier varicose veins and pelvic findings. Her two-year diagnostic odyssey ended with a vascular, not spinal or autoimmune, cause.
Part 4 – Closing Remarks:
This case illustrates how venous outflow obstruction can masquerade as back pain, gastrointestinal disease, or nonspecific systemic illness, and how pelvic congestion findings are often dismissed as incidental rather than clues to central venous compression. The strikingly focal, deep pain and multi-system venous features were key, yet the condition fell between specialties until imaging was reconsidered through a vascular lens. Nutcracker syndrome with secondary pelvic congestion accounted for the entire picture, and the dramatic response to stenting provided physiologic confirmation. It is a reminder that when tests are “normal,” the problem may lie not in missing inflammation or tumors, but in overlooked anatomy and blood flow.
