Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart is normal in size . The aorta is markedly tortuous . There is a large hiatal hernia , which projects over the left heart on the frontal view and contains a small pocket of gas . There is no focal consolidation , pleural effusion or pneumothorax . There is marked degenerative change throughout the thoracic spine as well as degenerative change seen at the glenohumeral joints bilaterally .
    OUTPUT:
    
1 . Moderate to large hiatal hernia . 2 . No acute cardiopulmonary process .