The author report the case of a 40-year-old male leisure scuba diver (height, 176 cm; weight, 73 kg) who died from asphyxiation by aspiration of gastric content, allegedly triggered by pulmonary hemosiderosis and/or full stomach. On the first dive of the day, the deceased complained of difficulty in descent and tried to descend several times but finally gave up and separated from his companions. After several minutes of separation, he was found dead, face down position on the sea surface, by the captain of the boat carrying the diving party. On autopsy, the lungs showed foreign bodies from stomach, intra-alveolar hemorrhage, and siderophages in the alveolar sac. A small amount of air bubbles was noted in the mesenteric vein, iliac artery, right ventricle and pulmonary artery. The cause of death was asphyxiation by aspiration of gastric content and pulmonary hemosiderosis, which probably provoked the event. Alveolar hemosiderosis may be a causal factor in fatal scuba diving accident.