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Begin by dicing the bell peppers, carrots, and red onion. Mince the garlic.
In a large pot, sauté the diced vegetables until they become tender.
Add the Italian sausage to the pot and cook until it is browned.
Stir in the tomato paste along with the cherry tomatoes, grape tomatoes, and canned tomatoes, adding water to the empty can to rinse it out.
Incorporate the sun-dried tomatoes and low sodium chicken broth, then add a Parmesan rind.
Season the mixture with salt and pepper, then allow the soup to simmer on low heat.
Once the flavors meld, pour in the heavy cream and stir well to combine.
Cook the fettuccine directly in the soup until it reaches an al dente texture, adding extra water if necessary.
Just before serving, add the spinach and let it wilt in the hot soup.
Remove the Parmesan rind, adjust the seasoning if needed, and serve the soup hot.