What are the two possibilities for the lucency projection through the L2 vertebral body?
It could represent a true bony lucency or bowel gas in the adjacent paravertebral gutter.
How would you further assess this?
In the correct clinical setting (e.g. increasing back pain, fever) and MRI is the ideal investigation. A CT would also answer the question of whether or not the lucency is within bone, but may miss more subtle changes.
The L2 vertebral body is slightly sclerotic with a lucency projecting over its mid portion. There is mild loss of disc height of the L2/3 level.