Clinical case reports of 3 children with recurrent respiratory papillomatosis who developed lung dissemination of the disease are presented. The radiological features of the primary pulmonary disease included papillomata in the distal airway and multiple, nodular lung lesions, both solid and cavitated. Changes secondary to pulmonary papillomatosis included atelectasis, infection and bronchiectasis. Respiratory papillomatosis involving pulmonary parenchyma is associated with a poor prognostic outcome. Early detection of such involvement and aggressive treatment of secondary infection are required to limit parenchymal damage.