In a large pot over medium heat, add your Italian sausage, crumbling it as it cooks. Sauté for about 5-7 minutes until browned.

Once the sausage is browned, add chopped onion and minced garlic to the pot. Cook for approximately 3-4 minutes until the onion is translucent.

Stir in the canned tomatoes, heavy cream, basil, oregano, and optional chili flakes. Let simmer for about 10-15 minutes.

While the sauce simmers, bring a large pot of salted water to a boil. Add the rigatoni and cook according to package instructions, typically around 10-12 minutes.

Add the drained rigatoni directly into the pot with the creamy sauce. Gently toss to ensure every piece is well coated.

Spoon the Creamy Italian Sausage Rigatoni into serving bowls and sprinkle with freshly grated Parmesan cheese. Garnish with fresh basil leaves.