This study investigated the distribution, pollution level and potential ecological risk of potentially toxic elements (PTEs) from manganese mining in a karstic Danshui River, in Changyang, Western Hubei, Central China. River water and sediments were collected for seven PTEs measurement (As, Cd, Cr, Cu, Mn, Pb and Zn), as well as pH and Eh of the river water were measured. Results showed that the major pollutant was Mn, the river water environment was mainly acidic and oxidizing (288 < Eh, pH < 6.3), and the pollution distribution of Mn in the study area was dominated by the combination of natural processes and anthropogenic activities. In the river water, according to the contamination factor (CF) and pollution load index (IPL) results, Mn was considered the main pollutant. There was low As and Pb pollution downstream as well as Cu pollution upstream. Upstream and downstream areas were the main polluted river sections of the river water samples collected. In river sediments, based on the results of the geo-accumulation index (Igeo) and potential ecological risk index (IPER), it was determined that there was only considerable Mn pollution. The IPER of the PTEs from the river sediments was at acceptable levels, only Mn upstream performed at a moderate ecological risk level. According to Pearson correlation and principal component analysis, Mn originated from manganese mining activities, Cd, Cr and Zn were of natural origin, and Cu may have come from both mining and natural origin, whereas Pb and As were mainly related to the daily activities. Consequently, elemental speciation, mining activities and the distribution of water conservancy facilities were the main impacts of PET pollution distribution in this river.