Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again demonstrated is a very large hiatal hernia . Allowing for relatively low lung volumes , heart is upper limits of normal in size . Aorta is tortuous and diffusely calcified . Pulmonary vascularity is normal . Increased opacity is seen overlying the lower thoracic spine on the lateral radiograph , and likely corresponds to bilateral small pleural effusions and adjacent atelectasis . Compression deformity at thoracolumbar junction appears similar to recent thoracic spine radiograph of ___ , and was more fully evaluated at that time .
    OUTPUT:
    
Very large hiatal hernia . Adjacent bibasilar opacities favor atelectasis , but aspiration pneumonia is not excluded in the appropriate setting .