Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are clear without focal opacity , pulmonary edema , pleural effusion or pneumothorax . The cardiac and mediastinal contours are stable . There is a large hiatal hernia . No acute osseous abnormality identified . Degenerative changes in the thoracic spine .
    OUTPUT:
    
No acute intrathoracic process . Large hiatal hernia again noted .