The imaging manifestations of multiple myeloma are divided into two parts. Because multiple myeloma is a migrating bone marrow lesion, it leads to bone destruction and osteoclast activity. The skeletal manifestations are osteoporosis and chisel-like bone destruction, and fractures can occur as the lesion progresses. Therefore, some patients, especially middle-aged and elderly, must pay attention to the possibility of spontaneous compression fractures to rule out myeloma. In addition to the effects of multiple myeloma on the bones, extramedullary myeloma lesions can occur, and sometimes it is necessary to assess whether there are such conditions outside the bone marrow. MRI and PET-CT are recommended to assess the extent of myeloma lesions and whether there is extramedullary invasion. Some patients may break their ribs by coughing. In this case, attention should be paid to screening patients for potential signs of myeloma, because most patients with multiple myeloma have a long medical history before the diagnosis of myeloma.