Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient is rotated somewhat to the left . Evidence a large hiatal hernia is again seen with adjacent atelectasis . There is blunting of the posterior costophrenic angle suggesting small pleural effusions , underlying consolidation not excluded . No pneumothorax is seen . The cardiac and mediastinal silhouettes are stable . No overt pulmonary edema is seen . Again seen dual lead left - sided pacemaker is stable position . Old right - sided rib fractures were better seen on the prior study , likely due to differences in patient position .
    OUTPUT:
    
Large hiatal hernia . Small bilateral pleural effusions , underlying consolidation not excluded .