FINDINGS:
The lungs are hyperinflated with flattening of the bilateral
 hemidiaphragms compatible with COPD.  No focal airspace opacity, significant
 pleural effusion or pneumothorax is detected.  The pulmonary vasculature is
 not engorged and there is no overt pulmonary edema.  The cardiac silhouette is
 normal in size.  The mediastinal contours and hilar contours are within normal
 limits.  There is tortuosity of the thoracic aorta.  An air-fluid level
 projects in the retrocardiac space compatible with a hiatal hernia.  Rib
 deformities are noted.  There is S-shaped thoracic scoliosis.

IMPRESSION:
1.  No acute cardiopulmonary process in the setting of COPD.  
 
 2.  Hiatal hernia. 
 
 3.  Rib deformities and S-shaped thoracic scoliosis.