Elevated concentrations of trace metals have been observed in the Mediterranean Sea. On the other hand, the rivers that flow into the Mediterranean receive trace metals derived from various anthropogenic and natural sources. The Sarno alluvial plain located in the southern Italy along the Eastern Tyrrhenian Sea, is one of the most polluted river basins in Europe. Consequently, study regarding contaminants in sediments of the continental shelf, offshore the Sarno River mouth, provides an opportunity to understand the role of the fluvial input in the Mediterranean Sea. Ninety-one seafloor sediment samples and twenty-two cores were collected along a transect offshore the Sarno river and analyzed for grain size, metals, TOC, and nutrients. The cores have been sampled at three different depths (0–20, 100–120, 180–200 cm). Statistical analyses were carried out aiming at investigating the variability in the distribution of metals, organic matter, and granulometric trend along the transect and in the associations between them. This approach has made it possible to recognize four distinct sectors (A, B, C, D). The metal distribution changes along the transect with the prevalence of metals anthropogenic in origin (Cr, Cu, Pb, Hg, Zn, Cd) in the sector B. Differentiation of sectors with different physical and geochemical associations permitted the reconstruction of the sediments pathway from source to sink. The core permitted to distinguish stratigraphic markers indicating that the sampled stratigraphic succession was deposited over the last 1945 years. The stratigraphic feature and the geologic frame witness that the wedge corresponds to a regressive succession. Whereas the onset of the anthropogenic influence on the sediment containing metals contamination is present only in the upper part of the cores and probably start in the 1944 and is located in correspondence of the river plume. This study makes a contribution to the origin and spatial-temporal variation of contaminants on the continental shelf that represent a link between the alluvial plain and the Mediterranean Sea.