Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are clear without consolidation or edema . There is no pleural effusion or pneumothorax . There is a large complex left - sided hiatal hernia which contains bowel contents . This is unchanged from the prior radiograph and CT . The cardiomediastinal silhouette is normal . There are significant degenerative changes in the bilateral shoulders . No definite rib fracture is visualized .
    OUTPUT:
    
1 . No acute cardiopulmonary process . 2 . No definite rib fracture visualized . If concern for rib fracture persists , could consider dedicated rib radiographs . 3 . Stable large complex hiatal hernia .