The degree and distribution of mercury (Hg) accumulation in sediment and fish from a tributary affected by alluvial small-scale gold mining in the Madeira River/Amazon is studied, in relation to a reference site. The results obtained so far agree well with previous studies and confirm that a tremendous contamination of main food web compartments occurs in these highly exposed, but vulnerable tropical waters. An essential part of the released metallic Hg may still exist as macroscopic liquid Hg drops in the sediment. Both global (0.4 mg/kg of Hg) and local (0.1 mg/kg of Hg) background sediment values as well as safety levels for fish (0.5 mg/kg of Hg) are considerably exceeded by a factor of up to 25, 100, and 4, respectively, and give rise to serious concern, not least with regard to the formation of the very toxic monomethyl-Hg. It is further discussed that atmospheric transport and deposition of Hg in water reservoirs built for hydroelectric power generation may act as critical pathways for longterm Hg accumulation, even in unexposed riverine systems.