Late presentation of bone cement implantation syndrome (BCIS) is rarely reported.
This case manifested late with resistant hypotension needing inotropic support.
BCIS was suspected by high right ventricular and pulmonary artery pressure and right ventricular outflow tract obstruction.
We diagnosed BCIS after ruling out other possibilities of resistant hypotension.
Our case report proves that BCIS can have delayed postoperative presentation.