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Bring a large pot of salted water to a rolling boil. Add the pasta and cook according to package directions until al dente. Reserve 1 cup of pasta cooking water before draining.

While the pasta cooks, heat olive oil in a large skillet or Dutch oven over medium-high heat. Add the Italian sausage, breaking it up with a spoon, and cook until browned and cooked through, about 5-7 minutes. Drain any excess fat.

Reduce heat to medium. Add the diced onion to the skillet and cook until softened, about 3-4 minutes. Add the minced garlic and red pepper flakes (if using) and cook for another minute until fragrant.

Pour in the crushed tomatoes, salt, and black pepper. Bring the sauce to a simmer, then reduce heat to low, cover, and let it cook for 10-15 minutes, allowing the flavors to meld.

Stir in the heavy cream and grated Parmesan cheese until well combined and heated through. If the sauce is too thick, add a splash of the reserved pasta cooking water until it reaches your desired consistency.

Add the drained pasta to the skillet with the sauce. Toss to coat evenly. Stir in the fresh chopped basil.

Serve immediately, garnished with extra grated Parmesan cheese and fresh basil, if desired.


Bring a large pot of salted water to a rolling boil. Add the pasta and cook according to package directions until al dente. Reserve 1 cup of pasta cooking water before draining.

While the pasta cooks, heat olive oil in a large skillet or Dutch oven over medium-high heat. Add the Italian sausage, breaking it up with a spoon, and cook until browned and cooked through, about 5-7 minutes. Drain any excess fat.

Reduce heat to medium. Add the diced onion to the skillet and cook until softened, about 3-4 minutes. Add the minced garlic and red pepper flakes (if using) and cook for another minute until fragrant.

Pour in the crushed tomatoes, salt, and black pepper. Bring the sauce to a simmer, then reduce heat to low, cover, and let it cook for 10-15 minutes, allowing the flavors to meld.

Stir in the heavy cream and grated Parmesan cheese until well combined and heated through. If the sauce is too thick, add a splash of the reserved pasta cooking water until it reaches your desired consistency.

Add the drained pasta to the skillet with the sauce. Toss to coat evenly. Stir in the fresh chopped basil.

Serve immediately, garnished with extra grated Parmesan cheese and fresh basil, if desired.
