Abstract Background: Acute appendicitis is the most prevalent cause of acute abdomen and subsequent surgery. Misdiagnosis is a common and critical problem in general surgery because the diagnosis is primarily based on clinical grounds. Maximum incidence observed in the second and third decades of life, with male preponderance. Graded compression ultrasonography is one of the diagnostic procedures that has been shown to reduce the need for unfavourable surgical treatments, particularly in females.Objectives: Objectives of the study were to study the clinical features of acute appendicitis, Utility of USG in supporting the clinical diagnosis of acute appendicitis. Methods: This study included one hundred and Twenty Five patients with history of RLQ pain where clinical diagnosis of acute appendicitis was made. The study period was of 18 months between November 2019 to May 2021. Routine bloodinvestigations and abdominal USG were done in all cases. All ultrasound positive cases were subjected to surgery. Some ultrasound negative cases were also taken to surgery on the high clinical suspicion of acute appendicitis. The ultrasound findings were compared with clinical findings and histopathological examination reports.