FINDINGS:
There is a large hiatal hernia with an air-fluid level.  The heart
 is mildly enlarged with a left ventricular configuration.  The cardiac,
 mediastinal and hilar contours appear unchanged.  The lungs appear clear aside
 from streaky atelectasis associated with a hiatal hernia in the left lower
 lung.  There is no pleural effusion or pneumothorax.  Small anterior
 osteophytes are noted along the mid-to-lower thoracic spine.  There has been
 no significant change.

IMPRESSION:
No evidence of acute disease.  Large hiatal hernia.