Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Rotated positioning . The patient has a large hiatal hernia and paraesophageal hernia containing stomach , colon , and peritoneal fat . This likely accounts for the opacity seen in the right mid and lower zones . The right paratracheal opacity is likely accounted for by a large right thyroid nodule . Allowing for these opacities on the right , no definite superimposed infiltrate is identified . Possible minimal blunting of the right costophrenic angle . No focal infiltrate or effusion detected in the left lung . There is probable background hyperinflation / COPD . There is cardiomegaly . There is upper zone redistribution and very mild vascular plethora which could either relate to COPD for represent early CHF .
    OUTPUT:
    
Cardiomegaly . Possible early CHF . No obvious infiltrate . However , much of the right lung is obscured by the patient 's extremely large hernia as well as the large right thyroid nodule . Note is made that the CT obtained on ___ at 01 :17 did not show a pulmonary infiltrate , only mild right sided atelectasis .