Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided pacemaker device with leads terminating in the right atrium and right ventricle is in unchanged position . Large hiatal hernia again projects to the right of midline . Cardiac silhouette appears mildly enlarged but unchanged . The aorta is tortuous and demonstrates mild atherosclerotic calcification . Hilar contours are normal . Pulmonary vasculature is normal . Small left pleural effusion appears relatively unchanged compared to the prior exam . No pneumothorax is seen . Remote right - sided rib fractures are again noted .
    OUTPUT:
    
Small left pleural effusion , unchanged . Large hiatal hernia . No evidence of pulmonary edema .