Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest were obtained . Evidence of a large hiatal hernia is again seen . No definite new focal consolidation . There is no large pleural effusion , although trace pleural effusion would be difficult to exclude posteriorly . The cardiac silhouette is top normal to mildly enlarged . The aorta remains tortuous . Multiple old left - sided rib fractures are again demonstrated . Degenerative changes are again seen along the spine , although not well assessed .
    OUTPUT:
    
Evidence of large hiatal hernia again seen . No definite acute cardiopulmonary process .