Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Dual lead left - sided pacer device is seen with leads extending to the expected positions of the right atrium and right ventricle . The lungs are clear without focal consolidation . No pleural effusion or pneumothorax is seen . The cardiac and mediastinal silhouettes are unremarkable . Evidence of a large hiatal hernia is redemonstrated . Degenerative changes are again seen along the spine including DISH .
    OUTPUT:
    
No acute cardiopulmonary process . Large hiatal hernia .