Background: The emergency room's most dependable and accessible diagnostic imaging tools for detecting appendicitis early and averting catastrophic complications by ultrasound (US) computed tomography (CT) imaging. Objective: To evaluate the role of ultrasound and CT in the diagnosis of acute appendicitis and their impact on surgical outcomes. Patients and Methods: This study was carried out as a prospective cross-sectional in collaboration between Surgery and Radiology Departments, Faculty of Medicine, Cairo University, Cairo, Egypt. We included 45 patients who were presented by symptoms of acute appendicitis, examined by pelvi-abdominal US then contract enhanced CT. The results of both Ultrasound and CT were correlated with the surgical outcome aiming of the study for diagnosis of acute appendicitis. Results: A total of 45 patients were included in the final analysis of our cohort research. The average age of the patients was 25 years with a standard deviation of 9 years. Males represented 53.3% while females represented 46.7% of the included patients. Our analysis revealed that CT exhibited a higher sensitivity than US if we used a cutoff point 2 findings by CT 100% versus 60.4% in US, while both were equal in specificity 85.7% in both modalities. CT and US can significantly predict positive surgical outcome. Conclusion: Detection of acute appendicitis by Ultrasound and CT were prior to any surgical intervention, reduces the negative appendectomy rate and the complications that may occur due to either improper diagnosis or unnecessary intervention.