Charcoal or chocolate: what captures the heart?

When the pericardium is involved in an inflammatory process, the function as well as the macroscopic characteristics of the pericardium can become impaired. In general, classification of pericarditis is based on its aetiology and pathophysiology.1 However, it got to our attention that several authors use an alternative way to characterise different types of pericarditis, based on macroscopic resemblance to specific subjects. Thus, terms have arisen like ‘chocolate heart’ and ‘charcoal heart’. In this letter, we would like to underline the appropriateness of this etymology by sharing the postmortem radiographic image of a patient with a ‘porcelain heart’ as well as presenting other striking examples of pericardial abnormalities and the particular names that bind them. The indicated patient was referred to our hospital with the suspicion of constrictive pericarditis. His medical history reported pericardial calcifications of unknown aetiology. Furthermore, there was a suspicion of asbestos exposure in occupational setting. Cardiac MRI showed decreased filling of the left …