OBJECTIVE Furnish a more detailed anatomicopathological description of the epicardial lesions in chronic chagasic cardiopathy, evaluate their incidence and discuss their probable pathogenesis METHODS We examined the hearts of 39 chronic chagasic cardiopathy patients who underwent autopsies and submitted to histological analysis the epicardial lesions. RESULTS Milk spots, characterized by well defined white areas in the epicardium were found in 80% of the cases, mainly on the anterior face of the right ventricle. Histological analysis revealed abrupt fibrous thickening of the epicardium, with no elastic fibers, inflammation or blood vessels. Chagasic rosary, characterized by small round whitish granules deposited sequentially along the coronary vessels were present in 23% of the hearts. They presented the same histological structure as the milk spots, but interestingly were only found immediately above the coronary artery branches. Villous plaque was found on the apex or anterior face of 21% of the hearts. It is characterized by an exophytic aspect, probably due to previous localized pericardial adhesion. Microscopic analysis revealed foci of inflammatory infiltrate and vascular proliferation, typical of epicarditis still under organization. In addition to the lesions described above, the vast majority of cases presented sparse mononuclear inflammatory cells with occasional foci. CONCLUSIONS We concluded that epicardial lesions related to chronic chagasic heart disease are probably a result of epicardial reactions to chronic inflammatory process.