Acute appendicitis is a one of the common abdominal emergency with a lifetime prevalence of about 7%%1. Diagnosis of acute appendicitis includes clinical examination, laboratory tests, diagnostic scoring systems, computer programs as physician aids and imaging examination. The clinical diagnosis of acute appendicitis remains a challenge to physicians and surgeons with a significant portion of patients initially misdiagnosed due to atypical clinical presentations and nonspecific laboratory tests. Diagnostic scoring systems show wide variance in the diagnostic accuracy of the condition. Hence imaging modalities like ultrasound has gained major importance in the diagnostic work-up of patients with suspected acute appendicitis in order to keep both the negative appendectomy rate and the perforation rate low. Delay in diagnosis increases the risk of perforation and associated complications. Now, Ultrasonography (USG) is used to facilitate the diagnosis of acute appendicitis in an increasing extent in the current scenario in order to minimize the chances of both its under-diagnosis and over-diagnosis. The objective of this study is to determine if USG could change the clinical decision in the management of suspected acute appendicitis. © 2021 Elsevier B.V., All rights reserved.