Heat olive oil in a large pot over medium heat. Add sausage and cook until edges are golden, 3–4 minutes. Remove and set aside.
Add onion and garlic to the pot, sauté until fragrant.
Stir in tomatoes, broth, pasta, sausage, and seasonings. Bring to a boil, then simmer 10–12 minutes, stirring often.
Stir in cream and cheese if using. Mix until smooth.
Adjust seasoning, garnish with parsley, and serve hot.
