Multiple hereditary exostoses (MHE), also known as multiple osteochondromas, is an autosomal dominant disease that results in the development of osteochondromas throughout the body. The disease typically is diagnosed during childhood and requires lifelong monitoring and treatment of painful osteochondromas. Individuals with MHE must be monitored for complications that can arise and the potential malignant transformation of an osteochondroma into a chondrosarcoma. This article discusses the basic characteristics of MHE, genetic links, the role of medical imaging in diagnosis, and treatment options.