Begin by filling a large pot with water and adding a generous pinch of salt. Bring to a rolling boil, then add rigatoni and cook until al dente, about 10-12 minutes.

Heat a large skillet over medium-high heat, add Italian sausage, and cook for about 8-10 minutes until browned. Add onion halfway through.

Reduce heat to medium and add minced garlic. Cook for about 1 minute, stirring until fragrant.

Drain excess fat from the skillet, ensuring the sauce maintains a creamy consistency.

Add diced and crushed tomatoes to the skillet and bring to a gentle simmer, cooking for about 10 minutes.

Stir in heavy cream, add basil if using, and season with salt and pepper. Cook for an additional 2-3 minutes.

Drain cooked rigatoni and add to the skillet, tossing to coat with sauce. Add a splash of pasta cooking water if the sauce is too thick.

Serve immediately, topping with Parmesan cheese and extra basil if desired.