Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Heart size is normal . Mediastinal and hilar contours are unchanged with a large hiatal hernia containing an air - fluid level again noted . Pulmonary vasculature is not engorged . Lungs are hyperinflated with mild emphysematous changes again noted within the upper lobes . No focal consolidation , pleural effusion or pneumothorax is present . Multiple compression deformities within the thoracic spine are unchanged .
    OUTPUT:
    
Large hiatal hernia . No acute cardiopulmonary abnormality otherwise demonstrated .