Multiple myeloma (MM) is part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance (MGUS) to plasma cell leukemia. It can have a varied presentation ranging from asymptomatic to severely symptomatic depending on the extent of end organ involvement. The extramedullary spread of multiple myeloma is a rare entity resulting from the hematogenous spread of neoplastic plasma cells with a reported incidence of 7% to 18% in newly diagnosed MM (1). MM with extramedullary disease affecting multiple sites is an extremely rare entity (2). We report a case of multiple myeloma with pulmonary and intracardiac plasmacytoma at diagnosis in a 61-year-old male.