Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Patient is rotated to the left . Tracheostomy tube is noted . There is marked elevation of the left hemidiaphragm with concern for a left diaphragmatic hernia containing dilated air - filled gastrointestinal structures , likely stomach and possibly bowel . Adjacent thin lucency is worrisome for pneumoperitoneum which was seen on outside hospital CT earlier today . There is subsequent mediastinal shift to the right . No large pleural effusion is seen . No definite focal consolidation although there may be basilar atelectasis .
    OUTPUT:
    
Patient is rotated to the left . Large left - sided diaphragmatic hernia containing dilated air-filled structure , stomach and possibly bowel , with secondary shift of the mediastinum to the right . Evidence of pneumoperitoneum as seen on CT from outside hospital earlier today .