Place the sausage and the diced onion in a large sauce pan or cast iron skillet over medium high heat. Break up the meat and cook until the sausage is browned. Drain off any excess grease.
Then stir in the diced tomatoes, Italian seasoning, salt, pepper, water and half and half. Then stir in the elbow macaroni. Bring the mixture to a boil, cover and reduce the heat to a low simmer. Cook for 14-18 minutes until the pasta is tender.
Uncover and then remove the pan from the heat.
Stir in the cheddar cheese and allow the heat from the meal to melt the cheese. Serve while warm and enjoy!
Notes
*Refrigerate the leftovers in an air tight container for up to 5 days. You can easily make this recipe with ground beef or ground sausage if you prefer. We recommend shredding your own cheddar cheese for this recipe as it melts smoother and is more creamy.