To determine the role of ultrasound in diagnosis of different causes of iliac fossae pain and situations when CT is needed to confirm diagnosis. This study was carried out on fifty patients presented by iliac fossae pain, all patients were subjected to history taking followed by ultrasound examinations. CT examination was carried out for selected patients when ultrasound results weren't conclusive for confirmation of diagnosis in disputed cases. The imaging findings were correlated with the operative data and pathological results when available. In this study 14 patients (28%) were males and 36 patients (72%) were females with age ranging from 9 months up to 60 years all are presented by iliac fossae pain ,40% presented by left iliac fossa pain and 60% presented by right iliac fossa pain. Based on imaging findings on present study,16 patients were diagnosed with adnexal cysts and CT was done for one case with dermoid cyst to reach final diagnosis. Appendicitis was correctly diagnosed in 13 patients, only one patient of them was confirmed by CT to have appendicitis .Ectopic pregnancy discovered in 5 patients , intussusception in 3 patients,3 patients were diagnosed with psoas abscess and ultrasound guided biopsy was performed to confirm diagnosis for them ,3 patients diagnosed as having tubo-ovarian abscess one case confirmed by CT and ultrasound guided biopsy was done for the other 2 cases, two patients with colonic masses both confirmed by CT, one case with crohn`s disease and CT was performed to detect all complications, one patients diagnosed by lower ureteric stone, one patient with rectus muscle hematoma, one patient with mesenteric cyst and one patient had mid cyclic menstrual pain after induction therapy. Ultrasound was conclusive for diagnosis in 39 patients (78%) of all cases presented by iliac fossa pain whereas complementary CT was needed for 6 patients (12%) of cases to reach final diagnosis and 5 patients (10%) of cases were confirmed by ultrasound guided biopsy so Ultrasound is recommended as a primary imaging modality for patients with iliac fossae pain.