Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again seen is a very large hiatal hernia , unchanged in configuration since ___ . No superimposed pulmonary consolidation , pleural effusion , or pneumothorax is detected . The heart size remains normal . There is moderate tortuosity of the thoracic aorta . Calcifications are again seen throughout the trachea and proximal bronchi .
    OUTPUT:
    
Unchanged large hiatal hernia . No superimposed pulmonary consolidation .