Introduction: Ultrasound is commonly used as a tool for investigation of acute appendicitis in children. The accuracy of ultrasound in appendicitis depends on the ability to visualize the appendix and the potential contribution from secondary signs. The study was a retrospective analysis of children referred for sonographic investigation of possible acute appendicitis at an Australian tertiary pediatric hospital between January 2008 and December 2010. Material and Method: The present study was conducted on 100 pediatric patients with possible diagnosis of appendicitis at Department of Radiology, Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre, Hyderabad. Over a period of one year. All of the patients underwent initial clinical evaluation followed by ultrasonography (USG), which was used to assess the existence of signs associated with appendicitis or its complications. USG Imaging findings were then compared in patients with and without complications. False positive, false negative, true positive and true negative values were calculated. Sensitivity and specificity of ultrasonography in determining appendicitis was evaluated. Results: Of the 100 pediatric patients, 65 (65%) were male and 35 (35%) were female. There were also 65 (65%) true positive and 35 (35%) true negative cases based on ultrasonography findings. In our study, USG sensitivity was 83.6%, specificity was 80.6%, positive predictive value was 94.4%, and negative predictive value was 80.6%. Conclusion: Ultrasonography is indicated in the diagnosis of appendicitis in pediatric patients and has optimal sensitivity and specificity in the diagnosis. Furthermore, it is a suitable diagnostic method for evaluating complications of appendicitis.