Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual - lead pacemaker / ICD device is present . The heart is normal in size . The aortic arch is calcified . There is a large hiatal hernia with an air - fluid level projecting over the lower central mediastinum slightly to the right of midline . There is no pleural effusion or pneumothorax . Aside from streaky opacities , probably relating to the presence of the hernia , the lungs appear clear .
    OUTPUT:
    
Large hiatal hernia . In that setting , confluent left infrahilar opacity could be seen with associated atelectasis but is not entirely specific . Pneumonia is a differential consideration , however , in the appropriate setting . Correlation to prior radiographs is suggested if available .