You have to set binmode to STDOUT just like you did to the file. This example works off Windows running Apache2 and ActiveState perl 5.8

#!C:/Perl/bin/perl
use MP3::Tag;
my $mp3 = MP3::Tag->new("withimage.mp3") or die "no File";
$mp3->get_tags;
$id3v2 = $mp3->{ID3v2};
my $Pic = $id3v2->get_frame("APIC"); # returns
print "Content-type:image/jpeg\r\n\r\n";
binmode STDOUT;
print STDOUT $Pic->{_Data};
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