Place the sausage in a large pot over medium high heat and saute for 10 minutes, or until well browned. Drain the fat except for about 1 tablespoon, add the onions and garlic and saute for 5 more minutes.
Next add the beef stock, water, tomatoes, carrots, seasonings and tomato sauce. Bring to a boil, reduce heat to low and simmer for 2 hours, skimming any fat that may surface.
Add tortellinie. Simmer for 10 minutes, or until tortellini is fully cooked. Pour into individual bowls and garnish with the cheese.