Cook the tortellini according to package directions; drain.
Add the butter to a large skillet and cook the shrimp until almost cooked through; approximately 2-3 minutes.
Add the tomato, basil, garlic and horseradish and cook for another 1-2 minutes until the shrimp is cooked through and is white/pink and not clear.
Stir in the flour; then add the heavy cream and cheese. Mix well; then add the cooked tortellini and stir until all coated. Sprinkle with extra cheese and chopped basil for garnish.