Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A left - sided dual - chamber pacemaker device is again noted with lead position unchanged . Again seen is a large hiatal hernia . The lungs are clear . The heart is top size normal and the mediastinal and hilar contours are normal . There is no osseous abnormality . Of note , the trachea is deviated to the left most likely due to an enlarged thyroid . Compression fractures of the thoracic spine appear worse .
    OUTPUT:
    
1 . No evidence of acute cardiopulmonary process . 2 . Tracheal deviation to the left most likely due to an enlarged thyroid . Recommend thyroid ultrasound for further evaluation . 3 . Compression fractures of the thoracic spine appear worse from the prior examination .