Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again noted are emphysematous changes in both lungs . A large hiatal hernia is present . Small left pleural effusion with adjacent atelectasis . The right lung is clear . No pneumothorax identified . The size appearance of the cardiomediastinal silhouette is unchanged .
    OUTPUT:
    
Small left pleural effusion . No new focal consolidation is identified . Large hiatal hernia .