Objective: Acute appendicitis is a common surgical emergency. But often arriving at correct diagnosis is challenging. CT scan has reduced the rates of negative appendectomies but it has radiation risk. We compared CT with Alvarado score (AS) in acute appendicitis in terms of positive operative and histopathological findings with the aim to use CT evaluation appropriately. Patients and methods: We collected retrospectively data of 358 patients admitted in a single hospital over a period of one year. All patients had Alvarado scoring done at the time of admission. CT was performed in 293 patients on consultant directions. CT and AS were compared in correlation with positive histopathological findings. Results: The study included 224 males (62.56%) and 134 females (37.43%). CT was performed in 293 patients (81.84%) patients. 320 (89.38%) patients underwent surgery while 38 (10.615) patients were managed conservatively. Among the operated group, 268(83.75%) patients had uncomplicated appendicitis while 52 (16.25%) had complicated appendicitis. Histopathology was positive for appendicitis in 285 patients (89.06%). Conclusions: An AS of 7 and above is as significant as CT scan so for these patients one can rely on AS score for deciding surgery. On the other hand if scores are less than 6 and there is strong suspicion of Appendicitis one should go ahead with CT.