Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A very large hiatal hernia is again demonstrated , unchanged in configuration since the ___ radiographs . The heart size remains within normal limits . The hilar and mediastinal contours are normal . There is no focal consolidation , pneumothorax , or pleural effusion .
    OUTPUT:
    
No acute intrathoracic process . Unchanged large hiatal hernia .