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Abstract Acute appendicitis is a common problem in all age groups and clinical over diagnosis is very common. The aim of this study is to know the diagnostic value of maximal-outer-diameter (MOD) of the appendix. This was measured by high frequency ultrasound pro-be by graded compression technique in acute appendi-citis. This study was conducted in the departments of Diagnostic Radiology at Combined Military Hospital and Bahawal Victoria Hospital, Bahawalpur from 1st January 2009 to 1st November 2010. Ninety one pati-ents of 8 - 70 years old with a suspicion of acute appe-ndicitis based on Alvarado score of more than 7 were included. The appendix was scanned using a high resolution transducer (9 - 11 MHz linear transducer) the maximum outer diameter (MOD) was measured. Sixty nine were proved as acute appendicitis by biopsy. The sensitivity and positive predictive value of MOD of 8 mm or more in the diagnosis of acute appendicitis is 98.5% and 100% respectively. Key Words:Acute appendicitis; Graded compres-sion; Sensitivity; Diagnosis.