Brown Italian sausage with garlic.
Mix in carrots and onion.
Add in flour to coat.
Stir in tomato paste and let cook for a few minutes until incorporated.
Add in Italian seasoning.
Deglaze with broth and water.
Bring to boil.
Add in heavy cream.
Lower heat and stir in tortellini.
Add spinach, cover, and simmer on low for five minutes.