Background :Acute appendicitis is one of the most common surgical emergencies with a lifetime prevalence of approximately 1 in 7. The Alvarado scoring system and ultrasonography play a definite role in diagnosis of acute appendicitis, because of the easy availability, cost effectiveness and being radiation free. According to the analysis, the percentage of Appendicectomies done for a normal appendix mistaken to be Acute Appendicitis was found to be as high as 20%.The following study compares the accuracy of the Alvorado scoring system and Ultrasonography in the diagnosis of Acute appendicitis and examines the value of using both modalities together. Materials and Methods :In this study 100 patients were included with provisional diagnosis of acute appendicitis and admitted and operated in the Department of General Surgery, MGM Medical College, Navi Mumbai between January 2021 to November 2022. Alvarado score was applied and ultra sound abdomen was done pre operatively. The decision for surgery was made independent of the score and ultra sound finding. Diagnosis of patients who underwent appendicectomy was confirmed by histopathology report. Results :In the present study, 100 cases were provisionally diagnosed of having acute appendicitis and were operated during the study period.Itwas seen that 95.52% of patients who were thought to be positive by Alvarado score >=7 usually had appendicitis by histopathology where as 4.08% of the patients were normal by histopathological examination. This accounted for 47.96% and 33.33% of the total patients respectively. From this the sensitivity of the Alvarado score is calculated to be 47.96%. Ultrasound alone showed a PPV of 67% and a NPV of 66.7%. Conclusion :In our study, Alvarado score had better sensitivity than ultrasonography. Alvarado score has a high diagnostic value (97.7%). USG has role in ruling out normal appendix and other pathology, with a specificity of 66.67% When we diagnose acute appendicitis based on the individual results of Alvarado score and USG, we get a statistically significant value. Hence as a conclusion of this study, alvaradoscore and USG together could be applied in the diagnosis of acute appendicitis for better outcomes and decision making.