Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest were provided . Midline sternotomy wires and mediastinal clips are again noted . A large hiatal hernia is again noted , with retrocardiac density significantly changed . There are small bilateral pleural effusions . There is no overt CHF . Minimal hilar congestion likely present . No pneumothorax . Bony structures are intact . The heart is top normal in size , though unchanged and the mediastinal contour is unremarkable .
    OUTPUT:
    
Minimal hilar congestion , tiny pleural effusions , large hiatal hernia .