Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left sided dual - chamber pacemaker device is noted with leads terminating in the right atrium and right ventricle . The heart size is moderately enlarged . There is a moderate - to - large hiatal hernia redemonstrated . Lung volumes are low with mild pulmonary vascular engorgement . Small bilateral pleural effusions are noted , and there is no pneumothorax . No acute osseous abnormality is seen .
    OUTPUT:
    
Moderate - to - large hiatal hernia with small bilateral pleural effusions and mild pulmonary vascular congestion .