Objective: Sonographic evaluation for acute appendicitis in children often involves an exhaustive protocol, for which the therapeutic yield has not been formally evaluated. The purpose of the study was to pilot a retrospective chart review of children receiving an abdominopelvic sonogram upon presenting with suspected acute appendicitis. Methods: An annual retrospective chart review was designed to review abdominopelvic sonograms to rule out appendicitis and specifically performed at a Canadian children’s teaching hospital. Studies were excluded if the requisition stated multiple clinical concerns or if the patient was >18 years at the time of the sonogram. Results: Based on 230 patient cases reviewed, alternative diagnostic sonographic findings were found in 141 (61%) charts. Only 18 patient cases (8%) demonstrated both alternative sonographic findings as well as a change in management by the emergency room physician. Conclusion: Alternative diagnostic findings, based on a complete abdominopelvic sonogram, were common (61%) in this chart review but rarely changed patient management.