BACKGROUND Appendicitis is a common cause for acute abdomen. Many literatures are available on imaging appendicitis and visualisation of normal appendix, but very limited studies for predominant contents of appendix by ultrasonography. Aim- To analyse contents of appendix in normal and inflamed appendix and to find if any content has association with inflammation of appendix and severity of inflammation. MATERIALS AND METHODS A prospective study was conducted in the period, January 2014 to January 2016. Two hundred patients were selected for this study, who presented with clinical symptoms and signs pertaining to acute appendicitis. The role of ultrasonography in detecting predominant content of appendix in normal and inflamed appendix and the results were analysed to associate if any specific content correlates with the inflammation of appendix and severity of inflammation. Contents analysed were lith (echogenic foci with posterior acoustic shadow), faecal matter (echogenic foci without posterior acoustic shadow), pus or fluid with faecal matter (fluid with internal echoes) and Mucocoele (fluid without internal echoes). RESULTS Echogenic foci without posterior acoustic shadow (faecal matter) was the more common content in normal appendix having diameter of 4.1-6 mm (27 %) (lith). Echogenic foci with posterior acoustic shadow (lith) are more common in inflamed appendix (7 %). Complication was also more common in inflamed appendix having lith as content. Echogenic foci with ring-down artefact or indistinct posterior shadow (air) was more common in normal appendix (4 %). Diameter of appendix is commonly less than 5.1 mm when air is the content of appendix. CONCLUSION Ultrasonography is an excellent mode of investigation to diagnose acute appendicitis. The usefulness of high frequency probe and graded compression method has a high diagnostic value for acute appendicitis. Evaluation of contents of appendix may be useful when diameter is intermediate around 6 mm. More weightage can be given to consideration that appendix is normal when the content is Faecal matter. When Fluid with internal echoes is present, it favours more towards acute appendicitis as diagnosis. Severity of inflammation is more when appendicolith is present, this may be due to obstruction caused by lith. In conclusion, evaluation of content of appendix is important in diagnosing acute appendicitis especially when diameter is intermediate. This is a first effort on evaluation of contents, further studies are needed.