Introduction: Pancoast-Tobias tumor (PTT), is a rare presentation of lung cancer that affects less than 5% of patients. Vertebral hemangioma is a benign tumor that develops in the endothelial lining of blood vessels. It is rarely symptomatic in adults, with only 0.9 to 1.2% of all vertebral hemangiomas being symptomatic. Materials and Methods: A 69 years old patient presented with right-sided chest pain, cough but no dyspnea associated with a weight loss of 10 kg over the past 06months. The patient reported inflammatory back pain that had been evolving for 2 years and had worsened in recent months. Chest X-ray-CT scan and MRI revealed a tumor mass in the apical segment of the right upper lobe extending into the right posterior mediastinal space at the costo-vertebral groove, measuring 38*33 mm with D2 and D3 vertebral body nodule in T1 isosignal, T2 hypersignal enhancing after gadolinium injection, consistent with an aggressive vertebral angioma (AVA). A multidisciplinary approach was organized, and the indication was to perform preoperative embolization, followed by hemivertebrectomy of D12 associated with costolobectomy. The patient refused to continue the treatment and passed away after 05 months. Discussion: Most vertebral angiomas are discovered incidentally and should not be treated. Pain is generally the most common symptom of discovery. MRI remains the most effective in exploring vertebral angiomas. PTT can extend to the cervicothoracic outlet, the diagnosis of these tumors calls for chest X-ray. Thoraco-abdomino-pelvic CT scan is part of the extension assessment and MRI allows for precise analysis. The management of the exclusive association of PTT and AVA remains a a challenge. Conclusion: The combination of PTT and a set of AVA is extremely rare and doesn’t appear to be described in the literature. The central problem remains the management, which is a challenge for the responsible surgical team.