Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Evaluation of cardiomediastinal silhouette is limited due to underlying large hiatal hernia . Known large hiatal hernia has increased in volume as compared to prior examinations , with increased amount of stomach seen within the chest and a new air - fluid level identified . Lungs appear grossly clear . There is no focal consolidation , pleural effusion or pneumothorax .
    OUTPUT:
    
Large hiatal hernia with increased amount of stomach in the chest as compared to prior examinations . If clinically indicated , dedicated UGI barium swallow is recommended to exclude obstruction , incarceration or torsion of the hernia .