Bronchiolar obstruction associated with repeated aspiration of vegetable material in two children with cerebral palsy

Chronic reactive bronchiolar obstruction has not been noted to occur with repeated aspiration of food materials. In this report, we describe two autopsy cases of children aged 8 years and 22 months with cerebral palsy, one with documented and treated esophageal reflux, and both with histories of repeated aspiration pneumonia. In each case, the lungs showed multiple nodules of hyalinized tissue and organized exudate obstructing the bronchiolar lumina, with multinucleated foreign body-type giant cells surrounding intraluminal vegetable particles. It is suggested that chronic bronchiolar obstruction was a significant contributing cause of respiratory insufficiency and consequent morbidity in these patients with cerebral palsy.