Despite its strategical importance, the diffusion of Project Risk Management (PRM) is limited mainly to large companies, leaving a lack of empirical evidence addressing small and medium-sized enterprises (SMEs). Therefore, the objective of this paper is to analyse how to adopt PRM in SMEs with a positive cost-benefit ratio, considering risk management (RM) phases, activities, tools, instruments, procedures and organisational aspects that enable the effective implementation of PRM in SMEs. To identify the fundamental dimensions to insert in the framework, a systematic literature review was performed, and a pilot case study was conducted to test the validity of the empirical framework and improve it. Moreover, after the case analysis, the benefits obtained and the difficulties faced through the adoption of PRM are presented and discussed.