Pulmonary cement embolism (PCE) is a rare but lethal complication. However, few long-term follow-up studies have investigated PCE after polymethylmethacrylate (PMMA) augmentation. This study aimed to investigate both the clinical and imaging outcomes of patients with PCE during a follow-up period of at least 5 years.A total of 1460 patients were initially included in this retrospective study. After exclusion, the clinical and imaging data were analyzed for selected patients, including the augmented level, location and length of the PCE, symptoms, therapy, migration and disintegration of the embolism, foreign body reaction, and status at follow-up.Twelve female patients (age range, 56-88 years) with PCE and more than five years of follow-up (range, 5-13 years) were eventually included. All emboli were found in subsegment pulmonary arteries and were classified as peripheral PCE. Although two patients experienced transient symptoms after surgery, the majority of patients (84.6%) were asymptomatic during follow-up. No other reported emboli were observed during the follow-up period. The imaging data showed that the cement embolus could remain in the initial position throughout the long-term follow-up. In terms of the length of the PCE, there was no statistically significant difference between the values post-operation and at the last follow-up time (P>0.05).Patients with peripheral PCE do not develop known late complications. Moreover, PMMA can remain stable and inert in the pulmonary vasculature over the long term. Routine prophylactic anticoagulation may not be necessary for patients with peripheral PCE during follow-up.Copyright © 2021 Elsevier Inc. All rights reserved.