Cook the rigatoni pasta in a large pot of salted boiling water according to package directions. Drain and set aside.
Heat a skillet over medium heat and cook Italian sausage until browned and cooked through. Drain excess fat.
Add diced tomatoes with juice, oregano, garlic powder, red pepper flakes, salt, and pepper. Simmer for 5-7 minutes.
Reduce heat and stir in heavy cream. Simmer for 5 minutes until thickened.
Return cooked rigatoni to the skillet and sprinkle with parmesan cheese. Toss to coat well.
Cook for 2-3 more minutes until pasta is heated through and sauce clings to pasta.
Transfer mixture to pressure cooker, seal lid, and pressure cook for a few minutes if desired. Perform quick release and serve.
Notes
Leftovers store well in the fridge for 3–4 days. Reheat with a splash of cream or milk for best texture. For freezer storage, use airtight containers and thaw overnight.