Objective To compare 128 slice helical CT and ultrasound for the diagnosis of acute appendicitis classification accuracy. Methods There are 50 cases Of 128 slice helical CT and ultrasound diagnosis of acute appendicitis in Jiangsu No.2 Chinese medicine hospital, to Analysis retrospectively, and compared with postoperative pathological contrast analysis, comparing the two imaging equipment to the accuracy of the diagnosis of acute appendicitis types. Results The CT diagnosis of acute appendicitis diagnosis coincidence rate was 92% (46/50), including simple appendicitis in 17 cases, suppurative appendicitis in 21 cases,gangrenous (periappendicural abscess)appendicitis in 8 cases, CT for acute appendicitis classification diagnosis coincidence rate was 88.2% (15/17), 85.7% (18/21), 100% (8/8). The diagnostic accordance rate of ultrasound diagnosis of acute appendicitis was 84%(42/50), including simple appendicitis in 16 cases, suppurative appendicitis in 19 cases, gangrenous (periappendicural abscess) in 7 cases, ultrasonography in diagnosing acute appendicitis parting coincidence rate was 87.5% (14/16), 84.2% (16/19), 100% (7/7). Conclusion CT diagnosis of acute appendicitis classification accuracy is higher than ultrasound, but two checking methods for the diagnosis of acute appendicitis were statistically significant (P < 0.05), when negative results of ultrasound examination can be supplemented by CT examination, both combined, can improve the accuracy rate in diagnosis of acute appendicitis.